401k Plan data: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN plan

POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 401k Plan overview

Plan Name	POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN
Plan identification number	505

POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

POBLOCKI SIGN COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name: POBLOCKI SIGN COMPANY, LLC

Employer identification number (EIN): 391964031

NAIC Classification: 332300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2015-01-01 BRIAN JOHNSON
505 2014-01-01 BRIAN JOHNSON
505 2013-01-01 BRIAN JOHNSON
505 2012-01-01 DAVID DRURY
505 2011-01-01 DAVID J DRURY
505 2009-01-01 DAVID J DRURY
505 2008-01-01 DAVID J DRURY
505 2007-01-01 DAVID J DRURY
505 2006-01-01 DAVID J DRURY
505 2005-01-01 DAVID J DRURY
505 2004-01-01 DAVID J DRURY

Plan id#	Filing Submission Date	Name of Administrator
505	2015-01-01	BRIAN JOHNSON
505	2014-01-01	BRIAN JOHNSON
505	2013-01-01	BRIAN JOHNSON
505	2012-01-01	DAVID DRURY
505	2011-01-01	DAVID J DRURY
505	2009-01-01	DAVID J DRURY
505	2008-01-01	DAVID J DRURY
505	2007-01-01	DAVID J DRURY
505	2006-01-01	DAVID J DRURY
505	2005-01-01	DAVID J DRURY
505	2004-01-01	DAVID J DRURY

Plan Statistics for POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN

401k plan membership statisitcs for POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN

Measure Date Value
2015: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 139
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 0
Total of all active and inactive participants 2015-01-01 139
2014: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 144
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 0
Total of all active and inactive participants 2014-01-01 144
2013: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 139
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 0
Total of all active and inactive participants 2013-01-01 139
2012: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 116
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 118
2011: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 173
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 0
Total of all active and inactive participants 2011-01-01 173
2009: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 153
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 0
Total of all active and inactive participants 2009-01-01 153
2008: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 141
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 141
2007: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 131
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 0
Total of all active and inactive participants 2007-01-01 131
2006: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year 2006-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 126
Number of retired or separated participants receiving benefits 2006-01-01 0
Number of other retired or separated participants entitled to future benefits 2006-01-01 0
Total of all active and inactive participants 2006-01-01 126
2005: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year 2005-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2005-01-01 121
Number of retired or separated participants receiving benefits 2005-01-01 0
Number of other retired or separated participants entitled to future benefits 2005-01-01 0
Total of all active and inactive participants 2005-01-01 121
2004: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year 2004-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2004-01-01 128
Number of retired or separated participants receiving benefits 2004-01-01 0
Number of other retired or separated participants entitled to future benefits 2004-01-01 0
Total of all active and inactive participants 2004-01-01 128

Measure	Date	Value
2015: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	139
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	0
Total of all active and inactive participants	2015-01-01	139
2014: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	144
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	0
Total of all active and inactive participants	2014-01-01	144
2013: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	139
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	0
Total of all active and inactive participants	2013-01-01	139
2012: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	116
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	118
2011: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	173
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	0
Total of all active and inactive participants	2011-01-01	173
2009: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	153
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	0
Total of all active and inactive participants	2009-01-01	153
2008: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	141
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	141
2007: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	131
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	0
Total of all active and inactive participants	2007-01-01	131
2006: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	126
Number of retired or separated participants receiving benefits	2006-01-01	0
Number of other retired or separated participants entitled to future benefits	2006-01-01	0
Total of all active and inactive participants	2006-01-01	126
2005: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2005 401k membership
Total participants, beginning-of-year	2005-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	121
Number of retired or separated participants receiving benefits	2005-01-01	0
Number of other retired or separated participants entitled to future benefits	2005-01-01	0
Total of all active and inactive participants	2005-01-01	121
2004: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2004 401k membership
Total participants, beginning-of-year	2004-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2004-01-01	128
Number of retired or separated participants receiving benefits	2004-01-01	0
Number of other retired or separated participants entitled to future benefits	2004-01-01	0
Total of all active and inactive participants	2004-01-01	128

Form 5500 Responses for POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN

2015: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2006: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2005: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – Insurance	Yes
2005-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-01-01	Plan benefit arrangement – Insurance	Yes
2005-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2004: POBLOCKI SIGN COMPANY, LLC GROUP BENEFIT PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	First time form 5500 has been submitted	Yes
2004-01-01	Submission has been amended	No
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No
2004-01-01	Plan funding arrangement – Insurance	Yes
2004-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-01-01	Plan benefit arrangement – Insurance	Yes
2004-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	4711
Policy instance	1
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	2
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	3
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	4
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	417002410913
Policy instance	5
OPTUM RX INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	01960934
Policy instance	6
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	303805
Policy instance	7
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	4
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	303805
Policy instance	7
OPTUM RX INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	01960934
Policy instance	6
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	417002410913
Policy instance	5
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	3
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	2
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	4711
Policy instance	1
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	4711
Policy instance	1
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	2
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	216772
Policy instance	4
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	417002410913
Policy instance	6
OPTUM RX INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	01960934
Policy instance	7
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	2
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	216772
Policy instance	4
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	4711
Policy instance	1
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	4711
Policy instance	1
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	2
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	216772
Policy instance	3
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	4
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number	663324
Policy instance	4
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	KM05598136
Policy instance	2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	716250
Policy instance	1
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	P95321
Policy instance	4
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	KM05598136
Policy instance	2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	383645
Policy instance	1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	KM05598136
Policy instance	2
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	P95321
Policy instance	4
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	383645
Policy instance	1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0
Policy instance	3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	P95321
Policy instance	5
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	4
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number	91884
Policy instance	2
COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 )
Policy contract number	91884
Policy instance	1
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	21398
Policy instance	3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	P95321
Policy instance	5
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	4
COMPCARE HEALTH SERVICES INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95693 )
Policy contract number	91884
Policy instance	1
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number	91884
Policy instance	2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	706139
Policy instance	2
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	P95321
Policy instance	7
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	21398
Policy instance	3
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number	21398/21498
Policy instance	4
SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC (National Association of Insurance Commissioners NAIC id number: 52005 )
Policy contract number	160900
Policy instance	5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	P95321
Policy instance	6
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	172490
Policy instance	1

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Company Name:	POBLOCKI SIGN COMPANY, LLC
Employer identification number (EIN):	391964031
NAIC Classification:	332300