401k Plan data: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN plan

SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 401k Plan overview

Plan Name	SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN
Plan identification number	003

SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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

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

Company Name: SIMCLAR, INC.

Employer identification number (EIN): 591709103

NAIC Classification: 335900

Additional information about SIMCLAR, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1976-11-05

Company Identification Number: 518024

Legal Registered Office Address: 1201 HAYS STREET

TALLAHASSEE

32301

More information about SIMCLAR, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2013-01-01 DAVID WEINSTEIN 2013-11-06
003 2012-01-01 DAVID WEINSTEIN
003 2011-01-01 ISABEL RODRIGUEZ DAVID WEINSTEIN 2012-10-12
003 2009-01-01 DAVID WEINSTEIN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2013-01-01	DAVID WEINSTEIN	2013-11-06
003	2012-01-01	DAVID WEINSTEIN
003	2011-01-01	ISABEL RODRIGUEZ		DAVID WEINSTEIN	2012-10-12
003	2009-01-01	DAVID WEINSTEIN

Plan Statistics for SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN

401k plan membership statisitcs for SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN

Measure Date Value
2012: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 12
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 34
Total of all active and inactive participants 2012-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 46
Number of participants with account balances 2012-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 132
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 71
Total of all active and inactive participants 2011-01-01 203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 203
Number of participants with account balances 2011-01-01 157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2009: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 321
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 182
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 78
Total of all active and inactive participants 2009-01-01 260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 260
Number of participants with account balances 2009-01-01 191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 40

Measure	Date	Value
2012: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	12
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	34
Total of all active and inactive participants	2012-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	46
Number of participants with account balances	2012-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	132
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	71
Total of all active and inactive participants	2011-01-01	203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	203
Number of participants with account balances	2011-01-01	157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2009: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	321
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	182
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	78
Total of all active and inactive participants	2009-01-01	260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	260
Number of participants with account balances	2009-01-01	191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	40

Financial Data on SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN

Measure	Date	Value
2012 : SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
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	$350,617
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$2,894,924
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$2,839,293
Expenses. Certain deemed distributions of participant loans	2012-12-31	$51,656
Value of total corrective distributions	2012-12-31	$628
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$91,248
Value of total assets at end of year	2012-12-31	$363,757
Value of total assets at beginning of year	2012-12-31	$2,908,064
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$3,347
Total interest from all sources	2012-12-31	$6,527
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	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$91,248
Participant contributions at end of year	2012-12-31	$1,271
Participant contributions at beginning of year	2012-12-31	$57,257
Administrative expenses (other) incurred	2012-12-31	$450
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	$-2,544,307
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$363,757
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,908,064
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
Investment advisory and management fees	2012-12-31	$2,897
Value of interest in pooled separate accounts at end of year	2012-12-31	$324,222
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$2,449,454
Interest on participant loans	2012-12-31	$1,508
Interest earned on other investments	2012-12-31	$5,019
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$38,264
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$401,353
Net investment gain/loss from pooled separate accounts	2012-12-31	$252,842
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$2,839,293
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	STROH, JOHNSON, & COMPANY, LLP
Accountancy firm EIN	2012-12-31	341454245
2011 : SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
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	$3,431
Total income from all sources (including contributions)	2011-12-31	$55,137
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$226,936
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$215,662
Value of total corrective distributions	2011-12-31	$4,693
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$148,809
Value of total assets at end of year	2011-12-31	$2,908,064
Value of total assets at beginning of year	2011-12-31	$3,083,294
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$6,581
Total interest from all sources	2011-12-31	$11,573
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
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
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	$148,809
Participant contributions at end of year	2011-12-31	$57,257
Participant contributions at beginning of year	2011-12-31	$92,457
Administrative expenses (other) incurred	2011-12-31	$234
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	$-171,799
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,908,064
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,079,863
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
Investment advisory and management fees	2011-12-31	$2,847
Value of interest in pooled separate accounts at end of year	2011-12-31	$2,449,454
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$2,559,276
Interest on participant loans	2011-12-31	$3,327
Interest earned on other investments	2011-12-31	$8,246
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$401,353
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$431,561
Net investment gain/loss from pooled separate accounts	2011-12-31	$-105,245
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$215,662
Contract administrator fees	2011-12-31	$3,500
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$3,431
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	STROH, JOHNSON, & COMPANY, LLP
Accountancy firm EIN	2011-12-31	341454245
2010 : SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$3,431
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	$447,949
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$304,293
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$301,486
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$163,920
Value of total assets at end of year	2010-12-31	$3,083,294
Value of total assets at beginning of year	2010-12-31	$2,936,207
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$2,807
Total interest from all sources	2010-12-31	$10,246
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	$500,000
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	$163,920
Participant contributions at end of year	2010-12-31	$92,457
Participant contributions at beginning of year	2010-12-31	$98,316
Participant contributions at beginning of year	2010-12-31	$5,593
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	$143,656
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,079,863
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,936,207
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
Investment advisory and management fees	2010-12-31	$2,807
Value of interest in pooled separate accounts at end of year	2010-12-31	$2,559,276
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$2,366,244
Interest earned on other investments	2010-12-31	$10,246
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$431,561
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$444,937
Net investment gain/loss from pooled separate accounts	2010-12-31	$273,783
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
Employer contributions (assets) at beginning of year	2010-12-31	$21,117
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$301,486
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$3,431
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	STROH, JOHNSON, & COMPANY, LLP
Accountancy firm EIN	2010-12-31	341454245
2009 : SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT 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 SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT PLAN

2012: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT 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 funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT 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 – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: SIMCLAR, INC. INCENTIVE SAVINGS AND RETIREMENT 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 – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

931238-01

Policy instance

Insurance contract or identification number	931238-01
Number of Individuals Covered	46
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,410
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,410
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE INVESTMENT RESEARCH INC

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

931238-01

Policy instance

Insurance contract or identification number	931238-01
Number of Individuals Covered	157
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,018
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

931238-01

Policy instance

Insurance contract or identification number	931238-01
Number of Individuals Covered	172
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,209
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 $11,209
Insurance broker organization code?	3
Insurance broker name	MML INVESTORS SERVICES INC.

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Company Name:	SIMCLAR, INC.
Employer identification number (EIN):	591709103
NAIC Classification:	335900

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1976-11-05
Company Identification Number:	518024
Legal Registered Office Address:	1201 HAYS STREET TALLAHASSEE 32301