401k Plan data: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN plan

BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	BME, INC. EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number	502

BME, INC. EMPLOYEE HEALTH BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

BENNER MECHANICAL & ELECTRICAL has sponsored the creation of one or more 401k plans.

Company Name: BENNER MECHANICAL & ELECTRICAL

Employer identification number (EIN): 200096574

NAIC Classification: 238220
NAIC Description: Plumbing, Heating, and Air-Conditioning Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BME, INC. EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2011-09-01 DANIEL ROSZKOWSKI 2014-02-05
502 2009-09-01 RALPH WALLACE 2011-06-16 RALPH WALLACE 2011-06-16
502 2009-09-01 DANIEL ROSZKOWSKI
502 2008-09-01 DANIEL ROSZKOWSKI
502 2007-09-01 DANIEL ROSZKOWSKI

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2011-09-01	DANIEL ROSZKOWSKI	2014-02-05
502	2009-09-01	RALPH WALLACE	2011-06-16	RALPH WALLACE	2011-06-16
502	2009-09-01	DANIEL ROSZKOWSKI
502	2008-09-01	DANIEL ROSZKOWSKI
502	2007-09-01	DANIEL ROSZKOWSKI

Plan Statistics for BME, INC. EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for BME, INC. EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2009: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 148
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 169
Number of retired or separated participants receiving benefits 2009-09-01 0
Number of other retired or separated participants entitled to future benefits 2009-09-01 0
Total of all active and inactive participants 2009-09-01 169
Total participants 2009-09-01 169
2008: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year 2008-09-01 128
Total number of active participants reported on line 7a of the Form 5500 2008-09-01 148
Number of retired or separated participants receiving benefits 2008-09-01 0
Number of other retired or separated participants entitled to future benefits 2008-09-01 0
Total of all active and inactive participants 2008-09-01 148
2007: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year 2007-09-01 118
Total number of active participants reported on line 7a of the Form 5500 2007-09-01 121
Number of retired or separated participants receiving benefits 2007-09-01 0
Number of other retired or separated participants entitled to future benefits 2007-09-01 0
Total of all active and inactive participants 2007-09-01 121

Measure	Date	Value
2009: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	148
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	169
Number of retired or separated participants receiving benefits	2009-09-01	0
Number of other retired or separated participants entitled to future benefits	2009-09-01	0
Total of all active and inactive participants	2009-09-01	169
Total participants	2009-09-01	169
2008: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year	2008-09-01	128
Total number of active participants reported on line 7a of the Form 5500	2008-09-01	148
Number of retired or separated participants receiving benefits	2008-09-01	0
Number of other retired or separated participants entitled to future benefits	2008-09-01	0
Total of all active and inactive participants	2008-09-01	148
2007: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year	2007-09-01	118
Total number of active participants reported on line 7a of the Form 5500	2007-09-01	121
Number of retired or separated participants receiving benefits	2007-09-01	0
Number of other retired or separated participants entitled to future benefits	2007-09-01	0
Total of all active and inactive participants	2007-09-01	121

Financial Data on BME, INC. EMPLOYEE HEALTH BENEFIT PLAN

Measure	Date	Value
2011 : BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-08-31	$0
Total income from all sources (including contributions)	2011-08-31	$1,583,220
Total loss/gain on sale of assets	2011-08-31	$0
Total of all expenses incurred	2011-08-31	$1,966,621
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-08-31	$1,875,582
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-08-31	$1,583,220
Value of total assets at end of year	2011-08-31	$-486,779
Value of total assets at beginning of year	2011-08-31	$-103,378
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-08-31	$91,039
Total interest from all sources	2011-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-08-31	$0
Was this plan covered by a fidelity bond	2011-08-31	Yes
Value of fidelity bond cover	2011-08-31	$1,000,000
Were there any nonexempt tranactions with any party-in-interest	2011-08-31	No
Contributions received from participants	2011-08-31	$238,413
Total non interest bearing cash at end of year	2011-08-31	$-486,779
Total non interest bearing cash at beginning of year	2011-08-31	$-103,378
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-08-31	No
Value of net income/loss	2011-08-31	$-383,401
Value of net assets at end of year (total assets less liabilities)	2011-08-31	$-486,779
Value of net assets at beginning of year (total assets less liabilities)	2011-08-31	$-103,378
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-08-31	No
Were any leases to which the plan was party in default or uncollectible	2011-08-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2011-08-31	$275,312
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-08-31	No
Was there a failure to transmit to the plan any participant contributions	2011-08-31	No
Has the plan failed to provide any benefit when due under the plan	2011-08-31	No
Contributions received in cash from employer	2011-08-31	$1,344,807
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-08-31	$1,600,270
Contract administrator fees	2011-08-31	$91,039
Did the plan have assets held for investment	2011-08-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-08-31	No
Opinion of an independent qualified public accountant for this plan	2011-08-31	Unqualified
Accountancy firm name	2011-08-31	GRAER AND COMPANY CPAS
Accountancy firm EIN	2011-08-31	311275871
2010 : BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-08-31	$0
Total income from all sources (including contributions)	2010-08-31	$1,548,506
Total loss/gain on sale of assets	2010-08-31	$0
Total of all expenses incurred	2010-08-31	$1,649,320
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-08-31	$1,586,192
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-08-31	$1,548,506
Value of total assets at end of year	2010-08-31	$-103,378
Value of total assets at beginning of year	2010-08-31	$-2,564
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-08-31	$63,128
Total interest from all sources	2010-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-08-31	No
Was this plan covered by a fidelity bond	2010-08-31	Yes
Value of fidelity bond cover	2010-08-31	$1,000,000
Were there any nonexempt tranactions with any party-in-interest	2010-08-31	No
Contributions received from participants	2010-08-31	$295,347
Total non interest bearing cash at end of year	2010-08-31	$-103,378
Total non interest bearing cash at beginning of year	2010-08-31	$-2,564
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-08-31	No
Value of net income/loss	2010-08-31	$-100,814
Value of net assets at end of year (total assets less liabilities)	2010-08-31	$-103,378
Value of net assets at beginning of year (total assets less liabilities)	2010-08-31	$-2,564
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-08-31	No
Were any leases to which the plan was party in default or uncollectible	2010-08-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2010-08-31	$227,297
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-08-31	No
Was there a failure to transmit to the plan any participant contributions	2010-08-31	No
Has the plan failed to provide any benefit when due under the plan	2010-08-31	No
Contributions received in cash from employer	2010-08-31	$1,253,159
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-08-31	$1,358,895
Contract administrator fees	2010-08-31	$63,128
Did the plan have assets held for investment	2010-08-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-08-31	No
Opinion of an independent qualified public accountant for this plan	2010-08-31	Unqualified
Accountancy firm name	2010-08-31	GREAR AND COMPANY CPAS
Accountancy firm EIN	2010-08-31	311275871
2009 : BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2009 401k financial data
Total unrealized appreciation/depreciation of assets	2009-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-08-31	$0
Total income from all sources (including contributions)	2009-08-31	$1,502,102
Total loss/gain on sale of assets	2009-08-31	$0
Total of all expenses incurred	2009-08-31	$1,499,443
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2009-08-31	$1,426,072
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2009-08-31	$1,502,102
Value of total assets at end of year	2009-08-31	$-2,564
Value of total assets at beginning of year	2009-08-31	$-5,223
Total of administrative expenses incurred including professional, contract, advisory and management fees	2009-08-31	$73,371
Total interest from all sources	2009-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2009-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2009-08-31	No
Administrative expenses professional fees incurred	2009-08-31	$37,004
Was this plan covered by a fidelity bond	2009-08-31	Yes
Value of fidelity bond cover	2009-08-31	$1,000,000
If this is an individual account plan, was there a blackout period	2009-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2009-08-31	No
Contributions received from participants	2009-08-31	$168,894
Administrative expenses (other) incurred	2009-08-31	$1,654
Total non interest bearing cash at end of year	2009-08-31	$-2,564
Total non interest bearing cash at beginning of year	2009-08-31	$-5,223
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2009-08-31	No
Value of net income/loss	2009-08-31	$2,659
Value of net assets at end of year (total assets less liabilities)	2009-08-31	$-2,564
Value of net assets at beginning of year (total assets less liabilities)	2009-08-31	$-5,223
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2009-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2009-08-31	No
Were any leases to which the plan was party in default or uncollectible	2009-08-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2009-08-31	$267,476
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2009-08-31	No
Was there a failure to transmit to the plan any participant contributions	2009-08-31	No
Has the plan failed to provide any benefit when due under the plan	2009-08-31	No
Contributions received in cash from employer	2009-08-31	$1,333,208
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2009-08-31	$1,158,596
Contract administrator fees	2009-08-31	$34,713
Did the plan have assets held for investment	2009-08-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2009-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2009-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2009-08-31	No
Opinion of an independent qualified public accountant for this plan	2009-08-31	Unqualified
Accountancy firm name	2009-08-31	GREAR AND COMPANY CPAS
Accountancy firm EIN	2009-08-31	311275871
2008 : BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2008 401k financial data
Total unrealized appreciation/depreciation of assets	2008-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-08-31	$0
Total income from all sources (including contributions)	2008-08-31	$1,159,594
Total loss/gain on sale of assets	2008-08-31	$0
Total of all expenses incurred	2008-08-31	$1,252,140
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2008-08-31	$1,190,067
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2008-08-31	$1,159,594
Value of total assets at end of year	2008-08-31	$-5,223
Value of total assets at beginning of year	2008-08-31	$87,323
Total of administrative expenses incurred including professional, contract, advisory and management fees	2008-08-31	$62,073
Total interest from all sources	2008-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2008-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2008-08-31	No
Administrative expenses professional fees incurred	2008-08-31	$21,961
Was this plan covered by a fidelity bond	2008-08-31	Yes
Value of fidelity bond cover	2008-08-31	$1,000,000
Were there any nonexempt tranactions with any party-in-interest	2008-08-31	No
Contributions received from participants	2008-08-31	$137,487
Administrative expenses (other) incurred	2008-08-31	$224
Total non interest bearing cash at end of year	2008-08-31	$-5,223
Total non interest bearing cash at beginning of year	2008-08-31	$87,323
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2008-08-31	No
Value of net income/loss	2008-08-31	$-92,546
Value of net assets at end of year (total assets less liabilities)	2008-08-31	$-5,223
Value of net assets at beginning of year (total assets less liabilities)	2008-08-31	$87,323
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2008-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2008-08-31	No
Were any leases to which the plan was party in default or uncollectible	2008-08-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2008-08-31	$258,458
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2008-08-31	No
Was there a failure to transmit to the plan any participant contributions	2008-08-31	No
Has the plan failed to provide any benefit when due under the plan	2008-08-31	No
Contributions received in cash from employer	2008-08-31	$1,022,107
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2008-08-31	$931,609
Contract administrator fees	2008-08-31	$39,888
Did the plan have assets held for investment	2008-08-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2008-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2008-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2008-08-31	No
Opinion of an independent qualified public accountant for this plan	2008-08-31	Unqualified
Accountancy firm name	2008-08-31	GREAR AND COMPANY CPAS
Accountancy firm EIN	2008-08-31	311275871

Form 5500 Responses for BME, INC. EMPLOYEE HEALTH BENEFIT PLAN

2009: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Submission has been amended	No
2009-09-01	This submission is the final filing	No
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-09-01	Plan is a collectively bargained plan	No
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2008 form 5500 responses
2008-09-01	Type of plan entity	Single employer plan
2008-09-01	Submission has been amended	Yes
2008-09-01	This submission is the final filing	No
2008-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-09-01	Plan is a collectively bargained plan	No
2008-09-01	Plan funding arrangement – Insurance	Yes
2008-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-09-01	Plan benefit arrangement – Insurance	Yes
2008-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: BME, INC. EMPLOYEE HEALTH BENEFIT PLAN 2007 form 5500 responses
2007-09-01	Type of plan entity	Single employer plan
2007-09-01	Submission has been amended	Yes
2007-09-01	This submission is the final filing	No
2007-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-09-01	Plan is a collectively bargained plan	No
2007-09-01	Plan funding arrangement – Insurance	Yes
2007-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-09-01	Plan benefit arrangement – Insurance	Yes
2007-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BERKLEY HEALTH AND LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 52413 )

Policy contract number

10332

Policy instance

Insurance contract or identification number	10332
Number of Individuals Covered	42
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $47,668
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	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 $275,312

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

Policy contract number

10332

Policy instance

Insurance contract or identification number	10332
Number of Individuals Covered	169
Insurance policy start date	2009-09-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $39,225
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	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 $227,297

BERKLEY HEALTH AND LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 52413 )

Policy contract number

10332

Policy instance

Insurance contract or identification number	10332
Number of Individuals Covered	42
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $47,668
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	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 $275,312
Commission paid to Insurance Broker	USD $34,058
Insurance broker organization code?	3
Insurance broker name	MEDICAL BENEFITS ADMINISTRATORS

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

10332

Policy instance

Insurance contract or identification number	10332
Number of Individuals Covered	148
Insurance policy start date	2008-09-01
Insurance policy end date	2009-08-31
Total amount of commissions paid to insurance broker	USD $39,638
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	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 $267,476

BERKLEY HEALTH AND LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 52413 )

Policy contract number

10332

Policy instance

Insurance contract or identification number	10332
Number of Individuals Covered	42
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $47,668
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	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 $275,312
Commission paid to Insurance Broker	USD $34,058
Insurance broker organization code?	3
Insurance broker name	MEDICAL BENEFITS ADMINISTRATORS

AIG MEDICAL EXCESS (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

10332

Policy instance

Insurance contract or identification number	10332
Number of Individuals Covered	121
Insurance policy start date	2007-09-01
Insurance policy end date	2008-08-31
Total amount of commissions paid to insurance broker	USD $38,775
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	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 $258,458

BERKLEY HEALTH AND LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 52413 )

Policy contract number

10332

Policy instance

Insurance contract or identification number	10332
Number of Individuals Covered	42
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $47,668
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	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 $275,312
Commission paid to Insurance Broker	USD $34,058
Insurance broker organization code?	3
Insurance broker name	MEDICAL BENEFITS ADMINISTRATORS

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Company Name:	BENNER MECHANICAL & ELECTRICAL
Employer identification number (EIN):	200096574
NAIC Classification:	238220
NAIC Description:	Plumbing, Heating, and Air-Conditioning Contractors