401k Plan data: DOCUMATION LLC 401(K) RETIREMENT PLAN plan

DOCUMATION LLC 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	DOCUMATION LLC 401(K) RETIREMENT PLAN
Plan identification number	001

DOCUMATION LLC 401(K) RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

DOCUMATION, LLC has sponsored the creation of one or more 401k plans.

Company Name: DOCUMATION, LLC

Employer identification number (EIN): 262300812

NAIC Classification: 423400

Additional information about DOCUMATION, LLC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1998-07-01

Company Identification Number: 601886624

Legal Registered Office Address: 707 W 41ST ST

VANCOUVER
United States of America (USA)
98660

More information about DOCUMATION, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOCUMATION LLC 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 AMY FREIERMUTH
001 2015-01-01 AMY FREIERMUTH
001 2014-01-01 AMY FREIERMUTH
001 2013-01-01 AMY FREIERMUTH
001 2012-01-01 XAMY FREIERMUTH
001 2011-01-01 AMY FREIERMUTH
001 2010-01-01 AMY FREIERMUTH

Plan id#	Filing Submission Date	Name of Administrator
001	2016-01-01	AMY FREIERMUTH
001	2015-01-01	AMY FREIERMUTH
001	2014-01-01	AMY FREIERMUTH
001	2013-01-01	AMY FREIERMUTH
001	2012-01-01	XAMY FREIERMUTH
001	2011-01-01	AMY FREIERMUTH
001	2010-01-01	AMY FREIERMUTH

Plan Statistics for DOCUMATION LLC 401(K) RETIREMENT PLAN

401k plan membership statisitcs for DOCUMATION LLC 401(K) RETIREMENT PLAN

Measure Date Value
2016: DOCUMATION LLC 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 326
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 315
Number of other retired or separated participants entitled to future benefits 2016-01-01 20
Total of all active and inactive participants 2016-01-01 335
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 335
Number of participants with account balances 2016-01-01 225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 10
2015: DOCUMATION LLC 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 327
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 300
Number of retired or separated participants receiving benefits 2015-01-01 26
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 326
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 326
Number of participants with account balances 2015-01-01 225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 12
2014: DOCUMATION LLC 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 334
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 306
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 21
Total of all active and inactive participants 2014-01-01 327
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 327
Number of participants with account balances 2014-01-01 218
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 23
2013: DOCUMATION LLC 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 315
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 294
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 26
Total of all active and inactive participants 2013-01-01 320
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 320
Number of participants with account balances 2013-01-01 216
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: DOCUMATION LLC 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 215
Number of retired or separated participants receiving benefits 2012-01-01 277
Number of other retired or separated participants entitled to future benefits 2012-01-01 20
Total of all active and inactive participants 2012-01-01 297
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 297
Number of participants with account balances 2012-01-01 180
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 8
2011: DOCUMATION LLC 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 181
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 201
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 13
Total of all active and inactive participants 2011-01-01 214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 214
Number of participants with account balances 2011-01-01 155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 8
2010: DOCUMATION LLC 401(K) RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 200
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 36
Total of all active and inactive participants 2010-01-01 236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 236
Number of participants with account balances 2010-01-01 181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 2

Measure	Date	Value
2016: DOCUMATION LLC 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	326
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	315
Number of other retired or separated participants entitled to future benefits	2016-01-01	20
Total of all active and inactive participants	2016-01-01	335
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	335
Number of participants with account balances	2016-01-01	225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	10
2015: DOCUMATION LLC 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	327
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	300
Number of retired or separated participants receiving benefits	2015-01-01	26
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	326
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	326
Number of participants with account balances	2015-01-01	225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	12
2014: DOCUMATION LLC 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	334
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	306
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	21
Total of all active and inactive participants	2014-01-01	327
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	327
Number of participants with account balances	2014-01-01	218
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	23
2013: DOCUMATION LLC 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	315
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	294
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	26
Total of all active and inactive participants	2013-01-01	320
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	320
Number of participants with account balances	2013-01-01	216
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: DOCUMATION LLC 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	215
Number of retired or separated participants receiving benefits	2012-01-01	277
Number of other retired or separated participants entitled to future benefits	2012-01-01	20
Total of all active and inactive participants	2012-01-01	297
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	297
Number of participants with account balances	2012-01-01	180
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	8
2011: DOCUMATION LLC 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	181
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	201
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	13
Total of all active and inactive participants	2011-01-01	214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	214
Number of participants with account balances	2011-01-01	155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	8
2010: DOCUMATION LLC 401(K) RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	200
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	36
Total of all active and inactive participants	2010-01-01	236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	236
Number of participants with account balances	2010-01-01	181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	2

Financial Data on DOCUMATION LLC 401(K) RETIREMENT PLAN

Measure	Date	Value
2016 : DOCUMATION LLC 401(K) RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$2,983,491
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$377,421
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$348,445
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,970,369
Value of total assets at end of year	2016-12-31	$14,279,676
Value of total assets at beginning of year	2016-12-31	$11,673,606
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$28,976
Total interest from all sources	2016-12-31	$14,854
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$485,990
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$485,990
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,216,531
Participant contributions at end of year	2016-12-31	$285,268
Participant contributions at beginning of year	2016-12-31	$289,018
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$328,888
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$2,606,070
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$14,279,676
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$11,673,606
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$11,148,645
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$9,460,593
Interest on participant loans	2016-12-31	$14,854
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$2,940
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$3,040
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$3,040
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$2,842,823
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,920,955
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$512,278
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$424,950
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$348,445
Contract administrator fees	2016-12-31	$28,976
Did the plan have assets held for investment	2016-12-31	Yes
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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	AKIN, DOHERTY KLEIN & FUEGE
Accountancy firm EIN	2016-12-31	742606559
2015 : DOCUMATION LLC 401(K) RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$1,275,037
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$433,005
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$289,717
Expenses. Certain deemed distributions of participant loans	2015-12-31	$62,200
Value of total corrective distributions	2015-12-31	$46,080
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,443,764
Value of total assets at end of year	2015-12-31	$11,673,606
Value of total assets at beginning of year	2015-12-31	$10,831,574
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$35,008
Total interest from all sources	2015-12-31	$12,216
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$453,433
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$453,433
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$966,235
Participant contributions at end of year	2015-12-31	$289,018
Participant contributions at beginning of year	2015-12-31	$275,959
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$151,862
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$842,032
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$11,673,606
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$10,831,574
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$9,460,593
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$8,949,479
Interest on participant loans	2015-12-31	$12,216
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$3,040
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$29,904
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$29,904
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,920,955
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,576,232
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-634,376
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$325,667
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$289,717
Contract administrator fees	2015-12-31	$35,008
Did the plan have assets held for investment	2015-12-31	Yes
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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	AKIN, DOHERTY, KLEIN & FUEGE
Accountancy firm EIN	2015-12-31	742606559
2014 : DOCUMATION LLC 401(K) RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$1,893,902
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$245,866
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$213,714
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,346,719
Value of total assets at end of year	2014-12-31	$10,831,574
Value of total assets at beginning of year	2014-12-31	$9,183,538
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$32,152
Total interest from all sources	2014-12-31	$9,343
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$471,836
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$471,836
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$901,619
Participant contributions at end of year	2014-12-31	$275,959
Participant contributions at beginning of year	2014-12-31	$143,073
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$106,191
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$1,648,036
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$10,831,574
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$9,183,538
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$32,152
Value of interest in pooled separate accounts at end of year	2014-12-31	$8,949,479
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$7,588,335
Interest on participant loans	2014-12-31	$9,343
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$29,904
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$34,920
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$34,920
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,576,232
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,417,210
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$66,004
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$338,909
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$213,714
Did the plan have assets held for investment	2014-12-31	Yes
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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	AKIN, DOHERTY, KLEIN & FUEGE
Accountancy firm EIN	2014-12-31	742606559
2013 : DOCUMATION LLC 401(K) RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$2,337,171
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$514,975
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$484,189
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,191,903
Value of total assets at end of year	2013-12-31	$9,183,538
Value of total assets at beginning of year	2013-12-31	$7,361,342
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$30,786
Total interest from all sources	2013-12-31	$6,754
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$284,795
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$284,795
Administrative expenses professional fees incurred	2013-12-31	$28,261
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$823,731
Participant contributions at end of year	2013-12-31	$143,073
Participant contributions at beginning of year	2013-12-31	$156,051
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$51,863
Administrative expenses (other) incurred	2013-12-31	$2,525
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Income. Non cash contributions	2013-12-31	$0
Value of net income/loss	2013-12-31	$1,822,196
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$9,183,538
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$7,361,342
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$7,588,335
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$5,740,196
Interest on participant loans	2013-12-31	$6,754
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$34,920
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$32,614
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$32,614
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,417,210
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$1,432,481
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$853,719
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$316,309
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$484,189
Did the plan have assets held for investment	2013-12-31	Yes
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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	AKIN, DOHERTY, KLEIN & FUEGE
Accountancy firm EIN	2013-12-31	742606559
2012 : DOCUMATION LLC 401(K) RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$1,872,930
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$198,831
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$165,664
Expenses. Certain deemed distributions of participant loans	2012-12-31	$8,976
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,144,884
Value of total assets at end of year	2012-12-31	$7,361,342
Value of total assets at beginning of year	2012-12-31	$5,687,243
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$24,191
Total interest from all sources	2012-12-31	$8,657
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$154,803
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$154,803
Administrative expenses professional fees incurred	2012-12-31	$22,514
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$762,361
Participant contributions at end of year	2012-12-31	$156,051
Participant contributions at beginning of year	2012-12-31	$176,577
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$83,945
Administrative expenses (other) incurred	2012-12-31	$1,677
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$1,674,099
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$7,361,342
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$5,687,243
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$5,740,196
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$4,300,391
Income. Interest from loans (other than to participants)	2012-12-31	$7,663
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$32,614
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$30,406
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$30,406
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$994
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$1,432,481
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$1,179,869
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$564,586
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$298,578
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$165,664
Did the plan have assets held for investment	2012-12-31	Yes
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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	AKIN, DOHERTY, KLEIN & FEUGE
Accountancy firm EIN	2012-12-31	742606559
2011 : DOCUMATION LLC 401(K) RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$930,587
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$227,835
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$130,465
Expenses. Certain deemed distributions of participant loans	2011-12-31	$10,590
Value of total corrective distributions	2011-12-31	$69,890
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,050,265
Value of total assets at end of year	2011-12-31	$5,687,243
Value of total assets at beginning of year	2011-12-31	$4,984,491
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$16,890
Total interest from all sources	2011-12-31	$29,902
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$703,101
Participant contributions at end of year	2011-12-31	$176,577
Participant contributions at beginning of year	2011-12-31	$117,803
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$78,014
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$702,752
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$5,687,243
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$4,984,491
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$16,890
Value of interest in pooled separate accounts at end of year	2011-12-31	$4,300,391
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$3,804,911
Interest on participant loans	2011-12-31	$7,078
Interest earned on other investments	2011-12-31	$22,824
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$30,406
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$25,263
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$25,263
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$1,179,869
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$1,036,514
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-149,580
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$269,150
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$130,465
Did the plan have assets held for investment	2011-12-31	Yes
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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	AKIN, DOHERTY, KLEIN & FEUGE
Accountancy firm EIN	2011-12-31	742606559
2010 : DOCUMATION LLC 401(K) RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$1,437,527
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$182,816
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$90,523
Value of total corrective distributions	2010-12-31	$78,558
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$923,116
Value of total assets at end of year	2010-12-31	$4,984,491
Value of total assets at beginning of year	2010-12-31	$3,729,780
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$13,735
Total interest from all sources	2010-12-31	$26,254
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$13,735
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$265,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$649,670
Participant contributions at end of year	2010-12-31	$117,803
Participant contributions at beginning of year	2010-12-31	$97,042
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$29,909
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$2,049
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$1,254,711
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$4,984,491
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,729,780
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$3,804,911
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$2,892,973
Interest on participant loans	2010-12-31	$5,484
Interest earned on other investments	2010-12-31	$20,770
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$25,263
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$25,959
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$25,959
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,036,514
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$713,806
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$488,157
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$243,537
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$88,474
Did the plan have assets held for investment	2010-12-31	Yes
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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	AKIN, DOHERTY, KLEIN & FEUGE
Accountancy firm EIN	2010-12-31	742606559

Form 5500 Responses for DOCUMATION LLC 401(K) RETIREMENT PLAN

2016: DOCUMATION LLC 401(K) RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple 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: DOCUMATION LLC 401(K) RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple 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: DOCUMATION LLC 401(K) RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple 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: DOCUMATION LLC 401(K) RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple 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: DOCUMATION LLC 401(K) RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple 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: DOCUMATION LLC 401(K) RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple 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: DOCUMATION LLC 401(K) RETIREMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Mulitple employer plan
2010-01-01	Submission has been amended	Yes
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

Insurance Providers Used on plan

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

Policy contract number

939887-01

Policy instance

Insurance contract or identification number	939887-01
Number of Individuals Covered	173
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,637
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
Amount paid for insurance broker fees	5637
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	SWBC INVESTMENT SERVICES LLC

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

Policy contract number

939887-01

Policy instance

Insurance contract or identification number	939887-01
Number of Individuals Covered	153
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,373
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
Amount paid for insurance broker fees	4373
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	SWBC INVESTMENT SERVICES LLC

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

Policy contract number

939887-01

Policy instance

Insurance contract or identification number	939887-01
Number of Individuals Covered	123
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,768
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
Commission paid to Insurance Broker	USD $3,768
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	SWBC INVESTMENT SERVICES LLC

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

Policy contract number

939887-01

Policy instance

Insurance contract or identification number	939887-01
Number of Individuals Covered	66
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,704
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
Commission paid to Insurance Broker	USD $4,704
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	SWBC INVESTMENT SERVICES LLC

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

Policy contract number

939887-01

Policy instance

Insurance contract or identification number	939887-01
Number of Individuals Covered	168
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $21,149
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

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

Policy contract number

939887-01

Policy instance

Insurance contract or identification number	939887-01
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $16,172
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

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Company Name:	DOCUMATION, LLC
Employer identification number (EIN):	262300812
NAIC Classification:	423400

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1998-07-01
Company Identification Number:	601886624
Legal Registered Office Address:	707 W 41ST ST VANCOUVER United States of America (USA) 98660