401k Plan data: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN plan

PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN
Plan identification number	001

PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PORTER SUPER CENTERS LLC has sponsored the creation of one or more 401k plans.

Company Name: PORTER SUPER CENTERS LLC

Employer identification number (EIN): 352045880

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 BOB SOTAK 2015-09-12
001 2013-01-01 BOB SOTAK 2014-09-22
001 2012-01-01 NANCY CAMP
001 2011-01-01 NANCY CAMP
001 2010-01-01 NANCY CAMP
001 2009-01-01 NANCY S CAMP

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2014-01-01	BOB SOTAK	2015-09-12
001	2013-01-01	BOB SOTAK	2014-09-22
001	2012-01-01	NANCY CAMP
001	2011-01-01	NANCY CAMP
001	2010-01-01	NANCY CAMP
001	2009-01-01	NANCY S CAMP

Plan Statistics for PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN

Measure Date Value
2012: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 67
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 11
Total of all active and inactive participants 2012-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 78
Number of participants with account balances 2012-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 11
2011: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 82
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 27
Total of all active and inactive participants 2011-01-01 109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 109
Number of participants with account balances 2011-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 6
2010: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 82
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 52
Total of all active and inactive participants 2010-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 134
Number of participants with account balances 2010-01-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 6
2009: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 82
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 47
Total of all active and inactive participants 2009-01-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 129
Number of participants with account balances 2009-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2012: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	67
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	11
Total of all active and inactive participants	2012-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	78
Number of participants with account balances	2012-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	11
2011: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	82
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	27
Total of all active and inactive participants	2011-01-01	109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	109
Number of participants with account balances	2011-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	6
2010: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	82
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	52
Total of all active and inactive participants	2010-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	134
Number of participants with account balances	2010-01-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	6
2009: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	82
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	47
Total of all active and inactive participants	2009-01-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	129
Number of participants with account balances	2009-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2012 : PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$6,386
Total transfer of assets from this plan	2012-12-31	$112,780
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	$82,709
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$39,959
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$33,100
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$44,104
Value of total assets at end of year	2012-12-31	$530,526
Value of total assets at beginning of year	2012-12-31	$594,170
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$6,859
Total interest from all sources	2012-12-31	$3,810
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$2,400
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$300,000
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	$29,247
Participant contributions at end of year	2012-12-31	$30,914
Participant contributions at beginning of year	2012-12-31	$32,629
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	$42,750
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$530,526
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$594,170
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	$346,864
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$372,282
Interest on participant loans	2012-12-31	$152
Interest earned on other investments	2012-12-31	$3,658
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$138,047
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$172,442
Net investment gain/loss from pooled separate accounts	2012-12-31	$34,795
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	$14,857
Employer contributions (assets) at end of year	2012-12-31	$14,701
Employer contributions (assets) at beginning of year	2012-12-31	$16,817
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$33,100
Contract administrator fees	2012-12-31	$4,459
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	SHEPARD SCHWARTZ & HARRIS LLP
Accountancy firm EIN	2012-12-31	361220454
2011 : PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$60,618
Total transfer of assets from this plan	2011-12-31	$45,350
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	$42,244
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$28,590
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$22,031
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$55,143
Value of total assets at end of year	2011-12-31	$594,170
Value of total assets at beginning of year	2011-12-31	$565,248
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$6,559
Total interest from all sources	2011-12-31	$4,489
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
Administrative expenses professional fees incurred	2011-12-31	$1,000
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$300,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$38,189
Participant contributions at end of year	2011-12-31	$32,629
Participant contributions at beginning of year	2011-12-31	$28,847
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
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	$13,654
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$594,170
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$565,248
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
Value of interest in pooled separate accounts at end of year	2011-12-31	$372,282
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$366,445
Interest on participant loans	2011-12-31	$282
Interest earned on other investments	2011-12-31	$4,207
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$172,442
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$152,248
Net investment gain/loss from pooled separate accounts	2011-12-31	$-17,388
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	$16,954
Employer contributions (assets) at end of year	2011-12-31	$16,817
Employer contributions (assets) at beginning of year	2011-12-31	$17,708
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$22,031
Contract administrator fees	2011-12-31	$5,559
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	SHEPARD SCHWARTZ & HARRIS LLP
Accountancy firm EIN	2011-12-31	361220454
2010 : PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$56,140
Total transfer of assets from this plan	2010-12-31	$120,410
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	$83,820
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$26,324
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$24,178
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$52,752
Value of total assets at end of year	2010-12-31	$565,248
Value of total assets at beginning of year	2010-12-31	$572,022
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$2,146
Total interest from all sources	2010-12-31	$5,435
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
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$300,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$35,062
Participant contributions at end of year	2010-12-31	$28,847
Participant contributions at beginning of year	2010-12-31	$33,313
Participant contributions at beginning of year	2010-12-31	$1,227
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
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	$57,496
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$565,248
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$572,022
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	$366,445
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$380,194
Interest on participant loans	2010-12-31	$1,361
Interest earned on other investments	2010-12-31	$4,074
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$152,248
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$139,471
Net investment gain/loss from pooled separate accounts	2010-12-31	$25,633
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
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	$17,690
Employer contributions (assets) at end of year	2010-12-31	$17,708
Employer contributions (assets) at beginning of year	2010-12-31	$17,817
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$24,178
Contract administrator fees	2010-12-31	$2,146
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	SHEPARD SCHWARTZ & HARRIS LLP
Accountancy firm EIN	2010-12-31	361220454
2009 : PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN

2012: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: PORTER SUPER CENTERS LLC 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

91652330

Policy instance

Insurance contract or identification number	91652330
Number of Individuals Covered	64
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,236
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 $618
Insurance broker organization code?	3
Insurance broker name	PAUL CAMPBELL

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

91652330

Policy instance

Insurance contract or identification number	91652330
Number of Individuals Covered	88
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,314
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

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

91652330

Policy instance

Insurance contract or identification number	91652330
Number of Individuals Covered	118
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $791
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:	PORTER SUPER CENTERS LLC
Employer identification number (EIN):	352045880
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores