401k Plan data: THE ASSURERX HEALTH RETIREMENT PLAN plan

THE ASSURERX HEALTH RETIREMENT PLAN 401k Plan overview

Plan Name	THE ASSURERX HEALTH RETIREMENT PLAN
Plan identification number	001

THE ASSURERX HEALTH RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

ASSUREX HEALTH, INC. has sponsored the creation of one or more 401k plans.

Company Name: ASSUREX HEALTH, INC.

Employer identification number (EIN): 271453375

NAIC Classification: 541700

Additional information about ASSUREX HEALTH, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2012-01-20

Company Identification Number: 0801538349

Legal Registered Office Address: 322 N 2200 W

SALT LAKE CTY
United States of America (USA)
84116

More information about ASSUREX HEALTH, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE ASSURERX HEALTH RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 VIRGINIA C. DROSOS
001 2015-01-01 DONALD WRIGHT
001 2014-01-01 DONALD WRIGHT
001 2013-01-01 DONALD WRIGHT 2014-07-17 DONALD WRIGHT 2014-07-17
001 2012-01-01 DONALD R WRIGHT JR 2013-06-23
001 2011-01-01 DONALD WRIGHT 2012-06-27 DONALD WRIGHT 2012-06-27
001 2010-01-01 DONALD R WRIGHT, JR. 2011-06-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	VIRGINIA C. DROSOS
001	2015-01-01	DONALD WRIGHT
001	2014-01-01	DONALD WRIGHT
001	2013-01-01	DONALD WRIGHT	2014-07-17	DONALD WRIGHT	2014-07-17
001	2012-01-01	DONALD R WRIGHT JR	2013-06-23
001	2011-01-01	DONALD WRIGHT	2012-06-27	DONALD WRIGHT	2012-06-27
001	2010-01-01	DONALD R WRIGHT, JR.	2011-06-20

Plan Statistics for THE ASSURERX HEALTH RETIREMENT PLAN

401k plan membership statisitcs for THE ASSURERX HEALTH RETIREMENT PLAN

Measure Date Value
2016: THE ASSURERX HEALTH RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 419
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: THE ASSURERX HEALTH RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 241
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 390
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 29
Total of all active and inactive participants 2015-01-01 419
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 419
Number of participants with account balances 2015-01-01 189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: THE ASSURERX HEALTH RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 228
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 13
Total of all active and inactive participants 2014-01-01 241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 241
Number of participants with account balances 2014-01-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2016: THE ASSURERX HEALTH RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	419
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: THE ASSURERX HEALTH RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	241
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	390
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	29
Total of all active and inactive participants	2015-01-01	419
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	419
Number of participants with account balances	2015-01-01	189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: THE ASSURERX HEALTH RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	228
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	13
Total of all active and inactive participants	2014-01-01	241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	241
Number of participants with account balances	2014-01-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on THE ASSURERX HEALTH RETIREMENT PLAN

Measure	Date	Value
2016 : THE ASSURERX HEALTH RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$0
Total transfer of assets from this plan	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	$2,237,040
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$5,807,740
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$5,712,671
Value of total corrective distributions	2016-12-31	$92,662
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,882,870
Value of total assets at end of year	2016-12-31	$0
Value of total assets at beginning of year	2016-12-31	$3,570,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,407
Total interest from all sources	2016-12-31	$972
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-12-31	$0
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,503,052
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$162,188
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	$-3,570,700
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,570,700
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 beginning of year	2016-12-31	$3,520,416
Interest earned on other investments	2016-12-31	$972
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$50,284
Net investment gain/loss from pooled separate accounts	2016-12-31	$353,198
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	No
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	$217,630
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$5,712,671
Contract administrator fees	2016-12-31	$2,407
Did the plan have assets held for investment	2016-12-31	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	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	Yes
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	RSM US LLP
Accountancy firm EIN	2016-12-31	420714325
2015 : THE ASSURERX HEALTH 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	$1,561,697
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$227,769
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$191,291
Value of total corrective distributions	2015-12-31	$35,098
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,606,258
Value of total assets at end of year	2015-12-31	$3,570,700
Value of total assets at beginning of year	2015-12-31	$2,236,772
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$1,380
Total interest from all sources	2015-12-31	$511
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$1,437,920
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$140,063
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	$1,333,928
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,570,700
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,236,772
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	$3,520,416
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$2,204,208
Interest earned on other investments	2015-12-31	$511
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$50,284
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$32,564
Net investment gain/loss from pooled separate accounts	2015-12-31	$-45,072
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	$28,275
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$191,291
Contract administrator fees	2015-12-31	$1,380
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	RSM US LLP
Accountancy firm EIN	2015-12-31	420714325
2014 : THE ASSURERX HEALTH 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	$1,043,722
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$168,617
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$166,636
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$938,644
Value of total assets at end of year	2014-12-31	$2,236,772
Value of total assets at beginning of year	2014-12-31	$1,361,667
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$1,981
Total interest from all sources	2014-12-31	$290
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Administrative expenses professional fees incurred	2014-12-31	$1,981
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	$824,556
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$113,741
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	$875,105
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,236,772
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,361,667
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
Value of interest in pooled separate accounts at end of year	2014-12-31	$2,204,208
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,328,356
Interest earned on other investments	2014-12-31	$290
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$1,476
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$1,476
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$32,564
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$31,835
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$21,562
Net investment gain/loss from pooled separate accounts	2014-12-31	$83,226
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	Yes
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	$347
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$166,636
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	MCGLADREY LLP
Accountancy firm EIN	2014-12-31	420714325

Form 5500 Responses for THE ASSURERX HEALTH RETIREMENT PLAN

2016: THE ASSURERX HEALTH RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
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: THE ASSURERX HEALTH RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: THE ASSURERX HEALTH RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

808912

Policy instance

Insurance contract or identification number	808912
Number of Individuals Covered	419
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,517
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	1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,517
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS, LLC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

808912

Policy instance

Insurance contract or identification number	808912
Number of Individuals Covered	241
Insurance policy start date	2014-02-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,687
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	1
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,687
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS, LLC

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Company Name:	ASSUREX HEALTH, INC.
Employer identification number (EIN):	271453375
NAIC Classification:	541700

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2012-01-20
Company Identification Number:	0801538349
Legal Registered Office Address:	322 N 2200 W SALT LAKE CTY United States of America (USA) 84116