401k Plan data: CONTROL4 CORPORATION WELFARE BENEFIT PLAN plan

CONTROL4 CORPORATION WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CONTROL4 CORPORATION WELFARE BENEFIT PLAN
Plan identification number	502

CONTROL4 CORPORATION WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

CONTROL 4 has sponsored the creation of one or more 401k plans.

Company Name: CONTROL 4

Employer identification number (EIN): 421583209

NAIC Classification: 334310
NAIC Description: Audio and Video Equipment Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONTROL4 CORPORATION WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2010-02-01 ALISON NIELSON ALISON NIELSON 2011-07-29
502 2010-02-01 ALISON NIELSON 2020-05-19
502 2009-02-01 DAN STRONG DAN STRONG 2010-08-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2010-02-01	ALISON NIELSON		ALISON NIELSON	2011-07-29
502	2010-02-01	ALISON NIELSON	2020-05-19
502	2009-02-01	DAN STRONG		DAN STRONG	2010-08-19

Plan Statistics for CONTROL4 CORPORATION WELFARE BENEFIT PLAN

401k plan membership statisitcs for CONTROL4 CORPORATION WELFARE BENEFIT PLAN

Measure Date Value
2010: CONTROL4 CORPORATION WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-02-01 205
Total number of active participants reported on line 7a of the Form 5500 2010-02-01 254
Number of retired or separated participants receiving benefits 2010-02-01 7
Total of all active and inactive participants 2010-02-01 261
Total participants 2010-02-01 261
Number of other retired or separated participants entitled to future benefits 2010-02-01 0
2009: CONTROL4 CORPORATION WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 198
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 203
Number of retired or separated participants receiving benefits 2009-02-01 2
Total of all active and inactive participants 2009-02-01 205
Total participants 2009-02-01 205

Measure	Date	Value
2010: CONTROL4 CORPORATION WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-02-01	205
Total number of active participants reported on line 7a of the Form 5500	2010-02-01	254
Number of retired or separated participants receiving benefits	2010-02-01	7
Total of all active and inactive participants	2010-02-01	261
Total participants	2010-02-01	261
Number of other retired or separated participants entitled to future benefits	2010-02-01	0
2009: CONTROL4 CORPORATION WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	198
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	203
Number of retired or separated participants receiving benefits	2009-02-01	2
Total of all active and inactive participants	2009-02-01	205
Total participants	2009-02-01	205

Form 5500 Responses for CONTROL4 CORPORATION WELFARE BENEFIT PLAN

2010: CONTROL4 CORPORATION WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-02-01	Type of plan entity	Single employer plan
2010-02-01	Submission has been amended	Yes
2010-02-01	This submission is the final filing	Yes
2010-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-02-01	Plan is a collectively bargained plan	No
2010-02-01	Plan funding arrangement – Insurance	Yes
2010-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-02-01	Plan benefit arrangement – Insurance	Yes
2010-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: CONTROL4 CORPORATION WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

716363

Policy instance

Insurance contract or identification number	716363
Number of Individuals Covered	838
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $98,908
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
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 $2,120,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $98,908
Insurance broker organization code?	3
Other welfare benefits provided	BABY YOURSELF, AIRMED

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

682228

Policy instance

Insurance contract or identification number	682228
Number of Individuals Covered	260
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $8,907
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
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 $267,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,907
Insurance broker organization code?	3

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

9911548152 000

Policy instance

Insurance contract or identification number	9911548152 000
Number of Individuals Covered	43
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $3,979
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
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 $17,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,646
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

220002G

Policy instance

Insurance contract or identification number	220002G
Number of Individuals Covered	156
Insurance policy start date	2010-02-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $9,535
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $73,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,535
Insurance broker organization code?	3

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Company Name:	CONTROL 4
Employer identification number (EIN):	421583209
NAIC Classification:	334310
NAIC Description:	Audio and Video Equipment Manufacturing