401k Plan data: WYATT V.I., INC. 401K PLAN plan

WYATT V.I., INC. 401K PLAN 401k Plan overview

Plan Name	WYATT V.I., INC. 401K PLAN
Plan identification number	001

WYATT V.I., INC. 401K 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.
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

WYATT V.I., INC. has sponsored the creation of one or more 401k plans.

Company Name: WYATT V.I., INC.

Employer identification number (EIN): 660604443

NAIC Classification: 237990
NAIC Description: Other Heavy and Civil Engineering Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WYATT V.I., INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 LOU CARVELLI 2014-11-17 LOU CARVELLI 2014-11-17
001 2012-01-01 LOU CARVELLI
001 2011-01-01 LOU CARVELLI
001 2010-01-01 LOUIS D. CARVELLI
001 2009-01-01 JAMES J. JORDAN JR.

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	LOU CARVELLI	2014-11-17	LOU CARVELLI	2014-11-17
001	2012-01-01	LOU CARVELLI
001	2011-01-01	LOU CARVELLI
001	2010-01-01	LOUIS D. CARVELLI
001	2009-01-01	JAMES J. JORDAN JR.

Plan Statistics for WYATT V.I., INC. 401K PLAN

401k plan membership statisitcs for WYATT V.I., INC. 401K PLAN

Measure Date Value
2012: WYATT V.I., INC. 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 253
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 97
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 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 97
Number of participants with account balances 2012-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: WYATT V.I., INC. 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 157
Number of retired or separated participants receiving benefits 2011-01-01 5
Number of other retired or separated participants entitled to future benefits 2011-01-01 9
Total of all active and inactive participants 2011-01-01 171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 172
Number of participants with account balances 2011-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: WYATT V.I., INC. 401K PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 180
Number of retired or separated participants receiving benefits 2010-01-01 3
Number of other retired or separated participants entitled to future benefits 2010-01-01 10
Total of all active and inactive participants 2010-01-01 193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 194
Number of participants with account balances 2010-01-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: WYATT V.I., INC. 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 166
Number of retired or separated participants receiving benefits 2009-01-01 4
Number of other retired or separated participants entitled to future benefits 2009-01-01 10
Total of all active and inactive participants 2009-01-01 180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 181
Number of participants with account balances 2009-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2012: WYATT V.I., INC. 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	97
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	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	97
Number of participants with account balances	2012-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: WYATT V.I., INC. 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	157
Number of retired or separated participants receiving benefits	2011-01-01	5
Number of other retired or separated participants entitled to future benefits	2011-01-01	9
Total of all active and inactive participants	2011-01-01	171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	172
Number of participants with account balances	2011-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: WYATT V.I., INC. 401K PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	180
Number of retired or separated participants receiving benefits	2010-01-01	3
Number of other retired or separated participants entitled to future benefits	2010-01-01	10
Total of all active and inactive participants	2010-01-01	193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	194
Number of participants with account balances	2010-01-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: WYATT V.I., INC. 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	166
Number of retired or separated participants receiving benefits	2009-01-01	4
Number of other retired or separated participants entitled to future benefits	2009-01-01	10
Total of all active and inactive participants	2009-01-01	180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	181
Number of participants with account balances	2009-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on WYATT V.I., INC. 401K PLAN

Measure	Date	Value
2012 : WYATT V.I., INC. 401K 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	$297,649
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$3,320,409
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$3,320,409
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$327,085
Value of total assets at end of year	2012-12-31	$411,788
Value of total assets at beginning of year	2012-12-31	$3,434,548
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$2,573
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	Yes
Value of fidelity bond cover	2012-12-31	$30,000
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	$250,643
Participant contributions at end of year	2012-12-31	$353,303
Participant contributions at beginning of year	2012-12-31	$435,554
Participant contributions at beginning of year	2012-12-31	$40,259
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$17,957
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$7,423
Administrative expenses (other) incurred	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$-3,022,760
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$411,788
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$3,434,548
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$2,641,991
Interest on participant loans	2012-12-31	$2,573
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$-32,009
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$58,485
Employer contributions (assets) at end of year	2012-12-31	$58,485
Employer contributions (assets) at beginning of year	2012-12-31	$309,321
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$3,320,409
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
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	HARPER & PEARSON CO., PC
Accountancy firm EIN	2012-12-31	741695589
2011 : WYATT V.I., INC. 401K 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	$0
Total income from all sources (including contributions)	2011-12-31	$776,765
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$488,312
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$483,541
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$831,513
Value of total assets at end of year	2011-12-31	$3,434,548
Value of total assets at beginning of year	2011-12-31	$3,146,095
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$4,771
Total interest from all sources	2011-12-31	$6,383
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	No
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	$522,192
Participant contributions at end of year	2011-12-31	$435,554
Participant contributions at beginning of year	2011-12-31	$264,675
Participant contributions at end of year	2011-12-31	$40,259
Participant contributions at beginning of year	2011-12-31	$51,339
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$7,423
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$11,679
Administrative expenses (other) incurred	2011-12-31	$4,771
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	$288,453
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$3,434,548
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,146,095
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$2,641,991
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$2,508,750
Interest on participant loans	2011-12-31	$6,383
Net investment gain/loss from pooled separate accounts	2011-12-31	$-61,131
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$309,321
Employer contributions (assets) at end of year	2011-12-31	$309,321
Employer contributions (assets) at beginning of year	2011-12-31	$309,652
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$483,541
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
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	HARPER & PEARSON CO., PC
Accountancy firm EIN	2011-12-31	741695589
2010 : WYATT V.I., INC. 401K 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$980,599
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$291,909
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$287,409
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$827,875
Value of total assets at end of year	2010-12-31	$3,157,874
Value of total assets at beginning of year	2010-12-31	$2,469,184
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$4,500
Total interest from all sources	2010-12-31	$1,533
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	No
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$518,223
Participant contributions at end of year	2010-12-31	$276,214
Participant contributions at beginning of year	2010-12-31	$194,738
Participant contributions at end of year	2010-12-31	$51,339
Participant contributions at beginning of year	2010-12-31	$36,538
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$11,679
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$8,513
Administrative expenses (other) incurred	2010-12-31	$4,500
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	$688,690
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,157,874
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,469,184
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$2,508,990
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$1,993,752
Interest on participant loans	2010-12-31	$1,533
Net investment gain/loss from pooled separate accounts	2010-12-31	$151,191
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$309,652
Employer contributions (assets) at end of year	2010-12-31	$309,652
Employer contributions (assets) at beginning of year	2010-12-31	$235,643
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$287,409
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
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	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	FRANCISCO DEPUSOIR CPA
Accountancy firm EIN	2010-12-31	660480807

Form 5500 Responses for WYATT V.I., INC. 401K PLAN

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

Insurance Providers Used on plan

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

Policy contract number

GAP-54-JR94

Policy instance

Insurance contract or identification number	GAP-54-JR94
Number of Individuals Covered	106
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $31,814
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?	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

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

Policy contract number

GAP-54-JR94

Policy instance

Insurance contract or identification number	GAP-54-JR94
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $26,408
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?	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

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Company Name:	WYATT V.I., INC.
Employer identification number (EIN):	660604443
NAIC Classification:	237990
NAIC Description:	Other Heavy and Civil Engineering Construction