401k Plan data: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST plan

WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan Name	WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST
Plan identification number	004

WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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

WAGNER, FALCONER, AND JUDD, LTD. has sponsored the creation of one or more 401k plans.

Company Name: WAGNER, FALCONER, AND JUDD, LTD.

Employer identification number (EIN): 410984139

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2022-01-01
004 2021-01-01
004 2021-01-01
004 2020-01-01 TARYN KRUMWIEDE 2021-07-28
004 2019-01-01 MICHAEL DUPONT 2020-07-29
004 2018-01-01 MARK ANDERSON 2019-07-29
004 2017-01-01 MARK ANDERSON 2018-07-26
004 2016-01-01 MARK ANDERSON 2017-07-31
004 2016-01-01 MARK ANDERSON 2017-07-27
004 2015-01-01 MICHAEL DUPONT 2016-07-25
004 2014-01-01 TARYN KRUMWIEDE 2015-07-24 TARYN KRUMWIEDE 2015-07-24
004 2013-01-01 MARK ANDERSON 2014-07-29 MARK ANDERSON 2014-07-29
004 2012-01-01 MARK ANDERSON 2013-07-15 MARK ANDERSON 2013-07-15
004 2011-01-01 TRAVIS STENBERG 2012-05-29
004 2010-01-01 MICHAEL DUPONT
004 2009-01-01 MICHAEL DUPONT
004 2009-01-01 MICHAEL DUPONT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
004	2022-01-01
004	2021-01-01
004	2021-01-01
004	2020-01-01	TARYN KRUMWIEDE	2021-07-28
004	2019-01-01	MICHAEL DUPONT	2020-07-29
004	2018-01-01	MARK ANDERSON	2019-07-29
004	2017-01-01	MARK ANDERSON	2018-07-26
004	2016-01-01	MARK ANDERSON	2017-07-31
004	2016-01-01	MARK ANDERSON	2017-07-27
004	2015-01-01	MICHAEL DUPONT	2016-07-25
004	2014-01-01	TARYN KRUMWIEDE	2015-07-24	TARYN KRUMWIEDE	2015-07-24
004	2013-01-01	MARK ANDERSON	2014-07-29	MARK ANDERSON	2014-07-29
004	2012-01-01	MARK ANDERSON	2013-07-15	MARK ANDERSON	2013-07-15
004	2011-01-01	TRAVIS STENBERG	2012-05-29
004	2010-01-01	MICHAEL DUPONT
004	2009-01-01	MICHAEL DUPONT
004	2009-01-01	MICHAEL DUPONT

Plan Statistics for WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST

Measure Date Value
2022: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year 2022-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 64
Number of other retired or separated participants entitled to future benefits 2022-01-01 55
Total of all active and inactive participants 2022-01-01 119
Total participants 2022-01-01 119
Number of participants with account balances 2022-01-01 113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year 2021-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 62
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 55
Total of all active and inactive participants 2021-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 117
Number of participants with account balances 2021-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2010: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 68
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 51
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 15
Total of all active and inactive participants 2010-01-01 66
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 66
Number of participants with account balances 2010-01-01 66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 5
2009: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 63
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 54
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 9
Total of all active and inactive participants 2009-01-01 63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 63
Number of participants with account balances 2009-01-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 6

Measure	Date	Value
2022: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year	2022-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	64
Number of other retired or separated participants entitled to future benefits	2022-01-01	55
Total of all active and inactive participants	2022-01-01	119
Total participants	2022-01-01	119
Number of participants with account balances	2022-01-01	113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year	2021-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	62
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	55
Total of all active and inactive participants	2021-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	117
Number of participants with account balances	2021-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2010: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	68
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	51
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	15
Total of all active and inactive participants	2010-01-01	66
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	66
Number of participants with account balances	2010-01-01	66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	5
2009: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	63
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	54
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	9
Total of all active and inactive participants	2009-01-01	63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	63
Number of participants with account balances	2009-01-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	6

Financial Data on WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST

Measure	Date	Value
2022 : WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$-397,805
Total of all expenses incurred	2022-12-31	$265,474
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$190,716
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$334,885
Value of total assets at end of year	2022-12-31	$5,319,714
Value of total assets at beginning of year	2022-12-31	$5,982,993
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$74,758
Total interest from all sources	2022-12-31	$789
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$176,809
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$176,809
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$212,513
Participant contributions at end of year	2022-12-31	$58,872
Participant contributions at beginning of year	2022-12-31	$14,152
Total non interest bearing cash at beginning of year	2022-12-31	$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	2022-12-31	No
Value of net income/loss	2022-12-31	$-663,279
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$5,319,714
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,982,993
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$67,358
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$5,260,842
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$5,968,841
Interest on participant loans	2022-12-31	$789
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-910,288
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$122,372
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$190,716
Contract administrator fees	2022-12-31	$7,400
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	PENSION ASSURANCE LLP
Accountancy firm EIN	2022-12-31	300840934
2021 : WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$1,003,462
Total of all expenses incurred	2021-12-31	$342,209
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$265,756
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$310,499
Value of total assets at end of year	2021-12-31	$5,982,993
Value of total assets at beginning of year	2021-12-31	$5,321,740
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$76,453
Total interest from all sources	2021-12-31	$408
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$198,663
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$198,663
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$100,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$200,738
Participant contributions at end of year	2021-12-31	$14,152
Participant contributions at beginning of year	2021-12-31	$6,916
Other income not declared elsewhere	2021-12-31	$-30,740
Total non interest bearing cash at end of year	2021-12-31	$0
Total non interest bearing cash at beginning of year	2021-12-31	$30,740
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$661,253
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,982,993
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$5,321,740
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$5,968,841
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$5,314,824
Interest on participant loans	2021-12-31	$408
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$493,892
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$109,761
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$265,756
Contract administrator fees	2021-12-31	$76,453
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	PENSION ASSURANCE LLP
Accountancy firm EIN	2021-12-31	300840934
2010 : WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$593,131
Expenses. Total of all expenses incurred	2010-12-31	$91,605
Benefits paid (including direct rollovers)	2010-12-31	$91,605
Total plan assets at end of year	2010-12-31	$3,833,182
Total plan assets at beginning of year	2010-12-31	$3,331,656
Value of fidelity bond covering the plan	2010-12-31	$500,000
Assets. Value of tangible personal property	2010-12-31	$0
Total contributions received or receivable from participants	2010-12-31	$111,607
Assets. Value of loans (other than to participants)	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$327,643
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$501,526
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$3,833,182
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$3,331,656
Assets. Value of participant loans	2010-12-31	$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2010-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2010-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$0
Assets. Value of real-estate (other than employer real property)	2010-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2010-12-31	$0
Assets. Value of employer securities	2010-12-31	$0
Assets. Value of employer real property	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$153,881
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2010-12-31	0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2009 401k financial data
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2009-12-31	0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST

2022: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2010: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 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 funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: WAGNER, FALCONER & JUDD, LTD PROFIT SHARING PLAN AND TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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 – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

30284

Policy instance

Insurance contract or identification number	30284
Number of Individuals Covered	59
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $24,877
Total amount of fees paid to insurance company	USD $5,678
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,877
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE OVERRIDE
Insurance broker name	NATIONAL RETIREMENT PLAN ADVISORS

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0302840

Policy instance

Insurance contract or identification number	0302840
Number of Individuals Covered	3
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	WAGNER, FALCONER, AND JUDD, LTD.
Employer identification number (EIN):	410984139
NAIC Classification:	541600