HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 401k Plan overview

Plan Name	HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN
Plan identification number	001

HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing 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.

401k Sponsoring company profile

HUB CITY FORD, INC. has sponsored the creation of one or more 401k plans.

Company Name:	HUB CITY FORD, INC.
Employer identification number (EIN):	720374694
NAIC Classification:	441110
NAIC Description:	New Car Dealers

Additional information about HUB CITY FORD, INC.

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1982-01-14
Company Identification Number:	F63200
Legal Registered Office Address:	1199 HWY 90 EAST CRESTVIEW 32536

More information about HUB CITY FORD, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-09-01
001	2020-09-01
001	2019-09-01
001	2018-09-01
001	2017-09-01
001	2016-09-01	D.E. CITRON, III
001	2015-09-01	D.E. CITRON, III
001	2014-09-01	D.E. CITRON, III
001	2013-09-01	D.E. CITRON, III
001	2012-09-01	D.E. CITRON, III
001	2011-09-01	D.E. CITRON, III
001	2009-09-01	D.E. CITRON, III

Plan Statistics for HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN

401k plan membership statisitcs for HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN

Measure	Date	Value
2021: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	160
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	119
Number of retired or separated participants receiving benefits	2021-09-01	0
Number of other retired or separated participants entitled to future benefits	2021-09-01	36
Total of all active and inactive participants	2021-09-01	155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-09-01	0
Total participants	2021-09-01	155
Number of participants with account balances	2021-09-01	139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-09-01	12
2020: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	176
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	160
Number of retired or separated participants receiving benefits	2020-09-01	0
Number of other retired or separated participants entitled to future benefits	2020-09-01	0
Total of all active and inactive participants	2020-09-01	160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-09-01	0
Total participants	2020-09-01	160
Number of participants with account balances	2020-09-01	148
2019: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	143
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	153
Number of retired or separated participants receiving benefits	2019-09-01	0
Number of other retired or separated participants entitled to future benefits	2019-09-01	0
Total of all active and inactive participants	2019-09-01	153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-09-01	0
Total participants	2019-09-01	153
Number of participants with account balances	2019-09-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-09-01	6
2018: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-09-01	147
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	140
Number of retired or separated participants receiving benefits	2018-09-01	0
Number of other retired or separated participants entitled to future benefits	2018-09-01	0
Total of all active and inactive participants	2018-09-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-09-01	0
Total participants	2018-09-01	140
Number of participants with account balances	2018-09-01	131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-09-01	5
2017: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	148
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	137
Number of retired or separated participants receiving benefits	2017-09-01	0
Number of other retired or separated participants entitled to future benefits	2017-09-01	6
Total of all active and inactive participants	2017-09-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-09-01	0
Total participants	2017-09-01	143
Number of participants with account balances	2017-09-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-09-01	11
2016: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	157
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	128
Number of retired or separated participants receiving benefits	2016-09-01	10
Number of other retired or separated participants entitled to future benefits	2016-09-01	7
Total of all active and inactive participants	2016-09-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-09-01	0
Total participants	2016-09-01	145
Number of participants with account balances	2016-09-01	132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-09-01	2
2015: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	165
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	133
Number of retired or separated participants receiving benefits	2015-09-01	0
Number of other retired or separated participants entitled to future benefits	2015-09-01	18
Total of all active and inactive participants	2015-09-01	151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-09-01	0
Total participants	2015-09-01	151
Number of participants with account balances	2015-09-01	137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-09-01	7
2014: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	168
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	138
Number of retired or separated participants receiving benefits	2014-09-01	0
Number of other retired or separated participants entitled to future benefits	2014-09-01	19
Total of all active and inactive participants	2014-09-01	157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-09-01	0
Total participants	2014-09-01	157
Number of participants with account balances	2014-09-01	136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-09-01	3
2013: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	164
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	143
Number of retired or separated participants receiving benefits	2013-09-01	0
Number of other retired or separated participants entitled to future benefits	2013-09-01	11
Total of all active and inactive participants	2013-09-01	154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-09-01	1
Total participants	2013-09-01	155
Number of participants with account balances	2013-09-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-09-01	1
2012: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	159
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	133
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	13
Total of all active and inactive participants	2012-09-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-09-01	0
Total participants	2012-09-01	146
Number of participants with account balances	2012-09-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-09-01	6
2011: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	154
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	128
Number of retired or separated participants receiving benefits	2011-09-01	0
Number of other retired or separated participants entitled to future benefits	2011-09-01	15
Total of all active and inactive participants	2011-09-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-09-01	0
Total participants	2011-09-01	143
Number of participants with account balances	2011-09-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-09-01	7
2009: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	153
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	131
Number of retired or separated participants receiving benefits	2009-09-01	0
Number of other retired or separated participants entitled to future benefits	2009-09-01	9
Total of all active and inactive participants	2009-09-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-09-01	0
Total participants	2009-09-01	140
Number of participants with account balances	2009-09-01	121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-09-01	3

Financial Data on HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN

Measure	Date	Value
2022 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-08-31	$0
Total income from all sources (including contributions)	2022-08-31	$787,888
Total loss/gain on sale of assets	2022-08-31	$0
Total of all expenses incurred	2022-08-31	$578,048
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-08-31	$578,048
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-08-31	$477,917
Value of total assets at end of year	2022-08-31	$11,247,660
Value of total assets at beginning of year	2022-08-31	$11,037,820
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-08-31	$0
Total interest from all sources	2022-08-31	$309,971
Total dividends received (eg from common stock, registered investment company shares)	2022-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-08-31	No
Was this plan covered by a fidelity bond	2022-08-31	Yes
Value of fidelity bond cover	2022-08-31	$500,000
If this is an individual account plan, was there a blackout period	2022-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-08-31	No
Contributions received from participants	2022-08-31	$328,209
Participant contributions at end of year	2022-08-31	$13,452
Participant contributions at beginning of year	2022-08-31	$12,842
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-08-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-08-31	$0
Total non interest bearing cash at end of year	2022-08-31	$264,301
Total non interest bearing cash at beginning of year	2022-08-31	$499
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-08-31	No
Value of net income/loss	2022-08-31	$209,840
Value of net assets at end of year (total assets less liabilities)	2022-08-31	$11,247,660
Value of net assets at beginning of year (total assets less liabilities)	2022-08-31	$11,037,820
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-08-31	No
Were any leases to which the plan was party in default or uncollectible	2022-08-31	No
Income. Interest from corporate debt instruments	2022-08-31	$307,298
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-08-31	$399,285
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-08-31	$349,202
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-08-31	$349,202
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-08-31	$2,673
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-08-31	$10,563,129
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-08-31	$10,669,570
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-08-31	No
Was there a failure to transmit to the plan any participant contributions	2022-08-31	No
Has the plan failed to provide any benefit when due under the plan	2022-08-31	No
Contributions received in cash from employer	2022-08-31	$149,708
Employer contributions (assets) at end of year	2022-08-31	$7,493
Employer contributions (assets) at beginning of year	2022-08-31	$5,707
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-08-31	$578,048
Did the plan have assets held for investment	2022-08-31	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	2022-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-08-31	No
Opinion of an independent qualified public accountant for this plan	2022-08-31	Unqualified
Accountancy firm name	2022-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2022-08-31	208102502
2021 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-08-31	$794
Total income from all sources (including contributions)	2021-08-31	$789,204
Total loss/gain on sale of assets	2021-08-31	$0
Total of all expenses incurred	2021-08-31	$882,408
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-08-31	$882,373
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-08-31	$466,835
Value of total assets at end of year	2021-08-31	$11,037,820
Value of total assets at beginning of year	2021-08-31	$11,131,818
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-08-31	$35
Total interest from all sources	2021-08-31	$322,369
Total dividends received (eg from common stock, registered investment company shares)	2021-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-08-31	No
Was this plan covered by a fidelity bond	2021-08-31	Yes
Value of fidelity bond cover	2021-08-31	$500,000
If this is an individual account plan, was there a blackout period	2021-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-08-31	No
Contributions received from participants	2021-08-31	$318,132
Participant contributions at end of year	2021-08-31	$12,842
Participant contributions at beginning of year	2021-08-31	$14,688
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-08-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-08-31	$794
Administrative expenses (other) incurred	2021-08-31	$35
Total non interest bearing cash at end of year	2021-08-31	$499
Total non interest bearing cash at beginning of year	2021-08-31	$1,514
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-08-31	No
Value of net income/loss	2021-08-31	$-93,204
Value of net assets at end of year (total assets less liabilities)	2021-08-31	$11,037,820
Value of net assets at beginning of year (total assets less liabilities)	2021-08-31	$11,131,024
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-08-31	No
Were any leases to which the plan was party in default or uncollectible	2021-08-31	No
Interest earned on other investments	2021-08-31	$320,624
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-08-31	$349,202
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-08-31	$238,062
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-08-31	$238,062
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-08-31	$1,745
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-08-31	$10,669,570
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-08-31	$10,869,629
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-08-31	No
Was there a failure to transmit to the plan any participant contributions	2021-08-31	No
Has the plan failed to provide any benefit when due under the plan	2021-08-31	No
Contributions received in cash from employer	2021-08-31	$148,703
Employer contributions (assets) at end of year	2021-08-31	$5,707
Employer contributions (assets) at beginning of year	2021-08-31	$7,925
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-08-31	$882,373
Did the plan have assets held for investment	2021-08-31	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	2021-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-08-31	No
Opinion of an independent qualified public accountant for this plan	2021-08-31	Unqualified
Accountancy firm name	2021-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2021-08-31	208102502
2020 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-08-31	$794
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-08-31	$0
Total income from all sources (including contributions)	2020-08-31	$811,581
Total loss/gain on sale of assets	2020-08-31	$0
Total of all expenses incurred	2020-08-31	$580,036
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-08-31	$580,016
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-08-31	$450,528
Value of total assets at end of year	2020-08-31	$11,131,818
Value of total assets at beginning of year	2020-08-31	$10,899,479
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-08-31	$20
Total interest from all sources	2020-08-31	$361,053
Total dividends received (eg from common stock, registered investment company shares)	2020-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-08-31	No
Was this plan covered by a fidelity bond	2020-08-31	Yes
Value of fidelity bond cover	2020-08-31	$500,000
If this is an individual account plan, was there a blackout period	2020-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-08-31	No
Contributions received from participants	2020-08-31	$310,324
Participant contributions at end of year	2020-08-31	$14,688
Participant contributions at beginning of year	2020-08-31	$10,932
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-08-31	$794
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-08-31	$0
Administrative expenses (other) incurred	2020-08-31	$20
Total non interest bearing cash at end of year	2020-08-31	$1,514
Total non interest bearing cash at beginning of year	2020-08-31	$3,067
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-08-31	No
Value of net income/loss	2020-08-31	$231,545
Value of net assets at end of year (total assets less liabilities)	2020-08-31	$11,131,024
Value of net assets at beginning of year (total assets less liabilities)	2020-08-31	$10,899,479
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-08-31	No
Were any leases to which the plan was party in default or uncollectible	2020-08-31	No
Interest earned on other investments	2020-08-31	$357,747
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-08-31	$238,062
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-08-31	$226,918
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-08-31	$226,918
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-08-31	$3,306
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-08-31	$10,869,629
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-08-31	$10,654,207
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-08-31	No
Was there a failure to transmit to the plan any participant contributions	2020-08-31	No
Has the plan failed to provide any benefit when due under the plan	2020-08-31	No
Contributions received in cash from employer	2020-08-31	$140,204
Employer contributions (assets) at end of year	2020-08-31	$7,925
Employer contributions (assets) at beginning of year	2020-08-31	$4,355
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-08-31	$580,016
Did the plan have assets held for investment	2020-08-31	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	2020-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-08-31	No
Opinion of an independent qualified public accountant for this plan	2020-08-31	Unqualified
Accountancy firm name	2020-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2020-08-31	208102502
2019 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-08-31	$0
Total income from all sources (including contributions)	2019-08-31	$726,030
Total loss/gain on sale of assets	2019-08-31	$0
Total of all expenses incurred	2019-08-31	$312,611
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-08-31	$312,289
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-08-31	$368,194
Value of total assets at end of year	2019-08-31	$10,899,479
Value of total assets at beginning of year	2019-08-31	$10,486,060
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-08-31	$322
Total interest from all sources	2019-08-31	$357,836
Total dividends received (eg from common stock, registered investment company shares)	2019-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-08-31	No
Was this plan covered by a fidelity bond	2019-08-31	Yes
Value of fidelity bond cover	2019-08-31	$500,000
If this is an individual account plan, was there a blackout period	2019-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-08-31	No
Contributions received from participants	2019-08-31	$264,187
Participant contributions at end of year	2019-08-31	$10,932
Participant contributions at beginning of year	2019-08-31	$9,657
Administrative expenses (other) incurred	2019-08-31	$322
Total non interest bearing cash at end of year	2019-08-31	$3,067
Total non interest bearing cash at beginning of year	2019-08-31	$1,361
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-08-31	No
Value of net income/loss	2019-08-31	$413,419
Value of net assets at end of year (total assets less liabilities)	2019-08-31	$10,899,479
Value of net assets at beginning of year (total assets less liabilities)	2019-08-31	$10,486,060
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-08-31	No
Were any leases to which the plan was party in default or uncollectible	2019-08-31	No
Interest earned on other investments	2019-08-31	$354,242
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-08-31	$226,918
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-08-31	$98,992
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-08-31	$98,992
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-08-31	$3,594
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-08-31	$10,654,207
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-08-31	$10,372,074
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-08-31	No
Was there a failure to transmit to the plan any participant contributions	2019-08-31	No
Has the plan failed to provide any benefit when due under the plan	2019-08-31	No
Contributions received in cash from employer	2019-08-31	$104,007
Employer contributions (assets) at end of year	2019-08-31	$4,355
Employer contributions (assets) at beginning of year	2019-08-31	$3,976
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-08-31	$312,289
Did the plan have assets held for investment	2019-08-31	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	2019-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-08-31	No
Opinion of an independent qualified public accountant for this plan	2019-08-31	Unqualified
Accountancy firm name	2019-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2019-08-31	208102502
2018 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-08-31	$0
Total income from all sources (including contributions)	2018-08-31	$713,633
Total loss/gain on sale of assets	2018-08-31	$0
Total of all expenses incurred	2018-08-31	$651,469
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-08-31	$651,469
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-08-31	$337,997
Value of total assets at end of year	2018-08-31	$10,486,060
Value of total assets at beginning of year	2018-08-31	$10,423,896
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-08-31	$0
Total interest from all sources	2018-08-31	$375,636
Total dividends received (eg from common stock, registered investment company shares)	2018-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-08-31	No
Was this plan covered by a fidelity bond	2018-08-31	Yes
Value of fidelity bond cover	2018-08-31	$500,000
If this is an individual account plan, was there a blackout period	2018-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-08-31	No
Contributions received from participants	2018-08-31	$236,935
Participant contributions at end of year	2018-08-31	$9,657
Participant contributions at beginning of year	2018-08-31	$9,795
Total non interest bearing cash at end of year	2018-08-31	$1,361
Total non interest bearing cash at beginning of year	2018-08-31	$35,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-08-31	No
Value of net income/loss	2018-08-31	$62,164
Value of net assets at end of year (total assets less liabilities)	2018-08-31	$10,486,060
Value of net assets at beginning of year (total assets less liabilities)	2018-08-31	$10,423,896
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-08-31	No
Were any leases to which the plan was party in default or uncollectible	2018-08-31	No
Interest earned on other investments	2018-08-31	$374,658
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-08-31	$98,992
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-08-31	$69,393
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-08-31	$69,393
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-08-31	$978
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-08-31	$10,372,074
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-08-31	$10,297,378
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-08-31	No
Was there a failure to transmit to the plan any participant contributions	2018-08-31	No
Has the plan failed to provide any benefit when due under the plan	2018-08-31	No
Contributions received in cash from employer	2018-08-31	$101,062
Employer contributions (assets) at end of year	2018-08-31	$3,976
Employer contributions (assets) at beginning of year	2018-08-31	$11,830
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-08-31	$651,469
Did the plan have assets held for investment	2018-08-31	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	2018-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-08-31	No
Opinion of an independent qualified public accountant for this plan	2018-08-31	Unqualified
Accountancy firm name	2018-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2018-08-31	208102502
2017 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-08-31	$0
Total income from all sources (including contributions)	2017-08-31	$707,972
Total loss/gain on sale of assets	2017-08-31	$0
Total of all expenses incurred	2017-08-31	$647,141
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-08-31	$647,071
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-08-31	$326,049
Value of total assets at end of year	2017-08-31	$10,423,896
Value of total assets at beginning of year	2017-08-31	$10,363,065
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-08-31	$70
Total interest from all sources	2017-08-31	$381,923
Total dividends received (eg from common stock, registered investment company shares)	2017-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-08-31	No
Was this plan covered by a fidelity bond	2017-08-31	Yes
Value of fidelity bond cover	2017-08-31	$500,000
If this is an individual account plan, was there a blackout period	2017-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-08-31	No
Contributions received from participants	2017-08-31	$256,514
Participant contributions at end of year	2017-08-31	$9,795
Participant contributions at beginning of year	2017-08-31	$15,710
Total non interest bearing cash at end of year	2017-08-31	$35,500
Total non interest bearing cash at beginning of year	2017-08-31	$906
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-08-31	No
Value of net income/loss	2017-08-31	$60,831
Value of net assets at end of year (total assets less liabilities)	2017-08-31	$10,423,896
Value of net assets at beginning of year (total assets less liabilities)	2017-08-31	$10,363,065
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-08-31	No
Were any leases to which the plan was party in default or uncollectible	2017-08-31	No
Investment advisory and management fees	2017-08-31	$70
Interest earned on other investments	2017-08-31	$379,527
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-08-31	$2,396
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-08-31	$10,297,378
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-08-31	$9,917,850
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-08-31	No
Was there a failure to transmit to the plan any participant contributions	2017-08-31	No
Has the plan failed to provide any benefit when due under the plan	2017-08-31	No
Contributions received in cash from employer	2017-08-31	$69,535
Employer contributions (assets) at end of year	2017-08-31	$11,830
Employer contributions (assets) at beginning of year	2017-08-31	$4,201
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-08-31	$647,071
Asset. Corporate debt instrument debt (other) at end of year	2017-08-31	$69,393
Asset. Corporate debt instrument debt (other) at beginning of year	2017-08-31	$424,398
Did the plan have assets held for investment	2017-08-31	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	2017-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-08-31	No
Opinion of an independent qualified public accountant for this plan	2017-08-31	Unqualified
Accountancy firm name	2017-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2017-08-31	208102502
2016 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-31	$0
Total income from all sources (including contributions)	2016-08-31	$1,056,590
Total loss/gain on sale of assets	2016-08-31	$0
Total of all expenses incurred	2016-08-31	$742,336
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-08-31	$742,106
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-08-31	$684,562
Value of total assets at end of year	2016-08-31	$10,363,065
Value of total assets at beginning of year	2016-08-31	$10,048,811
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-08-31	$230
Total interest from all sources	2016-08-31	$372,028
Total dividends received (eg from common stock, registered investment company shares)	2016-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-08-31	No
Was this plan covered by a fidelity bond	2016-08-31	Yes
Value of fidelity bond cover	2016-08-31	$500,000
If this is an individual account plan, was there a blackout period	2016-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-08-31	No
Contributions received from participants	2016-08-31	$406,881
Participant contributions at end of year	2016-08-31	$15,710
Participant contributions at beginning of year	2016-08-31	$15,039
Administrative expenses (other) incurred	2016-08-31	$230
Total non interest bearing cash at end of year	2016-08-31	$906
Total non interest bearing cash at beginning of year	2016-08-31	$1,768
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-08-31	No
Value of net income/loss	2016-08-31	$314,254
Value of net assets at end of year (total assets less liabilities)	2016-08-31	$10,363,065
Value of net assets at beginning of year (total assets less liabilities)	2016-08-31	$10,048,811
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-08-31	No
Were any leases to which the plan was party in default or uncollectible	2016-08-31	No
Interest earned on other investments	2016-08-31	$369,193
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-08-31	$424,398
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-08-31	$408,063
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-08-31	$408,063
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-08-31	$2,835
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-08-31	$9,917,850
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-08-31	$9,615,662
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-08-31	No
Was there a failure to transmit to the plan any participant contributions	2016-08-31	No
Has the plan failed to provide any benefit when due under the plan	2016-08-31	No
Contributions received in cash from employer	2016-08-31	$277,681
Employer contributions (assets) at end of year	2016-08-31	$4,201
Employer contributions (assets) at beginning of year	2016-08-31	$8,279
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-08-31	$742,106
Did the plan have assets held for investment	2016-08-31	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	2016-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-08-31	No
Opinion of an independent qualified public accountant for this plan	2016-08-31	Unqualified
Accountancy firm name	2016-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2016-08-31	208102502
2015 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$0
Total income from all sources (including contributions)	2015-08-31	$975,846
Total loss/gain on sale of assets	2015-08-31	$0
Total of all expenses incurred	2015-08-31	$737,457
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-08-31	$737,457
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-08-31	$616,389
Value of total assets at end of year	2015-08-31	$10,048,811
Value of total assets at beginning of year	2015-08-31	$9,810,422
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-08-31	$0
Total interest from all sources	2015-08-31	$359,457
Total dividends received (eg from common stock, registered investment company shares)	2015-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-08-31	No
Was this plan covered by a fidelity bond	2015-08-31	Yes
Value of fidelity bond cover	2015-08-31	$500,000
If this is an individual account plan, was there a blackout period	2015-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-08-31	No
Contributions received from participants	2015-08-31	$369,172
Participant contributions at end of year	2015-08-31	$15,039
Participant contributions at beginning of year	2015-08-31	$15,962
Total non interest bearing cash at end of year	2015-08-31	$1,768
Total non interest bearing cash at beginning of year	2015-08-31	$802
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-08-31	No
Value of net income/loss	2015-08-31	$238,389
Value of net assets at end of year (total assets less liabilities)	2015-08-31	$10,048,811
Value of net assets at beginning of year (total assets less liabilities)	2015-08-31	$9,810,422
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-08-31	No
Were any leases to which the plan was party in default or uncollectible	2015-08-31	No
Interest earned on other investments	2015-08-31	$355,812
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-08-31	$408,063
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-08-31	$808,448
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-08-31	$808,448
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-08-31	$3,645
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-08-31	$9,615,662
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-08-31	$8,974,151
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-08-31	Yes
Was there a failure to transmit to the plan any participant contributions	2015-08-31	No
Has the plan failed to provide any benefit when due under the plan	2015-08-31	No
Contributions received in cash from employer	2015-08-31	$247,217
Employer contributions (assets) at end of year	2015-08-31	$8,279
Employer contributions (assets) at beginning of year	2015-08-31	$11,059
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-08-31	$737,457
Did the plan have assets held for investment	2015-08-31	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	2015-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-08-31	No
Opinion of an independent qualified public accountant for this plan	2015-08-31	Unqualified
Accountancy firm name	2015-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2015-08-31	208102502
2014 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-08-31	$0
Total income from all sources (including contributions)	2014-08-31	$1,017,666
Total loss/gain on sale of assets	2014-08-31	$0
Total of all expenses incurred	2014-08-31	$167,476
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-08-31	$167,351
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-08-31	$651,463
Value of total assets at end of year	2014-08-31	$9,810,422
Value of total assets at beginning of year	2014-08-31	$8,960,232
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-08-31	$125
Total interest from all sources	2014-08-31	$366,203
Total dividends received (eg from common stock, registered investment company shares)	2014-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-08-31	No
Was this plan covered by a fidelity bond	2014-08-31	Yes
Value of fidelity bond cover	2014-08-31	$500,000
If this is an individual account plan, was there a blackout period	2014-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-08-31	No
Contributions received from participants	2014-08-31	$391,900
Participant contributions at end of year	2014-08-31	$15,962
Participant contributions at beginning of year	2014-08-31	$15,552
Total non interest bearing cash at end of year	2014-08-31	$802
Total non interest bearing cash at beginning of year	2014-08-31	$506
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-08-31	No
Value of net income/loss	2014-08-31	$850,190
Value of net assets at end of year (total assets less liabilities)	2014-08-31	$9,810,422
Value of net assets at beginning of year (total assets less liabilities)	2014-08-31	$8,960,232
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-08-31	No
Were any leases to which the plan was party in default or uncollectible	2014-08-31	No
Investment advisory and management fees	2014-08-31	$125
Interest earned on other investments	2014-08-31	$360,457
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-08-31	$808,448
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-08-31	$324,433
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-08-31	$324,433
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-08-31	$5,746
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-08-31	$8,974,151
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-08-31	$8,613,694
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-08-31	No
Was there a failure to transmit to the plan any participant contributions	2014-08-31	No
Has the plan failed to provide any benefit when due under the plan	2014-08-31	No
Contributions received in cash from employer	2014-08-31	$259,563
Employer contributions (assets) at end of year	2014-08-31	$11,059
Employer contributions (assets) at beginning of year	2014-08-31	$6,047
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-08-31	$167,351
Liabilities. Value of benefit claims payable at end of year	2014-08-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-08-31	$0
Did the plan have assets held for investment	2014-08-31	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	2014-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-08-31	No
Opinion of an independent qualified public accountant for this plan	2014-08-31	Unqualified
Accountancy firm name	2014-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2014-08-31	208102502
2013 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-08-31	$205
Total income from all sources (including contributions)	2013-08-31	$960,157
Total loss/gain on sale of assets	2013-08-31	$0
Total of all expenses incurred	2013-08-31	$648,420
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-08-31	$648,189
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-08-31	$607,962
Value of total assets at end of year	2013-08-31	$8,960,232
Value of total assets at beginning of year	2013-08-31	$8,648,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-08-31	$231
Total interest from all sources	2013-08-31	$352,195
Total dividends received (eg from common stock, registered investment company shares)	2013-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-08-31	No
Was this plan covered by a fidelity bond	2013-08-31	Yes
Value of fidelity bond cover	2013-08-31	$500,000
If this is an individual account plan, was there a blackout period	2013-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-08-31	No
Contributions received from participants	2013-08-31	$377,270
Participant contributions at end of year	2013-08-31	$15,552
Participant contributions at beginning of year	2013-08-31	$14,161
Total non interest bearing cash at end of year	2013-08-31	$506
Total non interest bearing cash at beginning of year	2013-08-31	$705
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-08-31	No
Value of net income/loss	2013-08-31	$311,737
Value of net assets at end of year (total assets less liabilities)	2013-08-31	$8,960,232
Value of net assets at beginning of year (total assets less liabilities)	2013-08-31	$8,648,495
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-08-31	No
Were any leases to which the plan was party in default or uncollectible	2013-08-31	No
Investment advisory and management fees	2013-08-31	$231
Interest earned on other investments	2013-08-31	$352,181
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-08-31	$324,433
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-08-31	$759,378
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-08-31	$759,378
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-08-31	$14
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-08-31	$8,613,694
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-08-31	$7,867,099
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-08-31	No
Was there a failure to transmit to the plan any participant contributions	2013-08-31	No
Has the plan failed to provide any benefit when due under the plan	2013-08-31	No
Contributions received in cash from employer	2013-08-31	$230,692
Employer contributions (assets) at end of year	2013-08-31	$6,047
Employer contributions (assets) at beginning of year	2013-08-31	$7,357
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-08-31	$648,189
Liabilities. Value of benefit claims payable at end of year	2013-08-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-08-31	$205
Did the plan have assets held for investment	2013-08-31	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	2013-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-08-31	No
Opinion of an independent qualified public accountant for this plan	2013-08-31	Unqualified
Accountancy firm name	2013-08-31	THIBODAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2013-08-31	208102502
2012 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-08-31	$205
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-08-31	$0
Total income from all sources (including contributions)	2012-08-31	$938,509
Total loss/gain on sale of assets	2012-08-31	$0
Total of all expenses incurred	2012-08-31	$169,371
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-08-31	$169,286
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-08-31	$568,736
Value of total assets at end of year	2012-08-31	$8,648,700
Value of total assets at beginning of year	2012-08-31	$7,879,357
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-08-31	$85
Total interest from all sources	2012-08-31	$369,773
Total dividends received (eg from common stock, registered investment company shares)	2012-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-08-31	No
Administrative expenses professional fees incurred	2012-08-31	$85
Was this plan covered by a fidelity bond	2012-08-31	Yes
Value of fidelity bond cover	2012-08-31	$500,000
If this is an individual account plan, was there a blackout period	2012-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-08-31	No
Contributions received from participants	2012-08-31	$346,430
Participant contributions at end of year	2012-08-31	$14,161
Participant contributions at beginning of year	2012-08-31	$12,291
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-08-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-08-31	$19
Total non interest bearing cash at end of year	2012-08-31	$705
Total non interest bearing cash at beginning of year	2012-08-31	$5,118
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-08-31	No
Value of net income/loss	2012-08-31	$769,138
Value of net assets at end of year (total assets less liabilities)	2012-08-31	$8,648,495
Value of net assets at beginning of year (total assets less liabilities)	2012-08-31	$7,879,357
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-08-31	No
Were any leases to which the plan was party in default or uncollectible	2012-08-31	No
Interest earned on other investments	2012-08-31	$363,798
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-08-31	$759,378
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-08-31	$352,591
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-08-31	$352,591
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-08-31	$5,975
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-08-31	$7,867,099
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-08-31	$7,503,301
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-08-31	No
Was there a failure to transmit to the plan any participant contributions	2012-08-31	No
Has the plan failed to provide any benefit when due under the plan	2012-08-31	No
Contributions received in cash from employer	2012-08-31	$222,306
Employer contributions (assets) at end of year	2012-08-31	$7,357
Employer contributions (assets) at beginning of year	2012-08-31	$6,037
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-08-31	$169,286
Liabilities. Value of benefit claims payable at end of year	2012-08-31	$205
Did the plan have assets held for investment	2012-08-31	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	2012-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-08-31	No
Opinion of an independent qualified public accountant for this plan	2012-08-31	Unqualified
Accountancy firm name	2012-08-31	THIBODEAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2012-08-31	208102502
2011 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-08-31	$0
Total income from all sources (including contributions)	2011-08-31	$846,277
Total loss/gain on sale of assets	2011-08-31	$0
Total of all expenses incurred	2011-08-31	$275,489
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-08-31	$275,489
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-08-31	$496,376
Value of total assets at end of year	2011-08-31	$7,879,357
Value of total assets at beginning of year	2011-08-31	$7,308,569
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-08-31	$0
Total interest from all sources	2011-08-31	$349,901
Total dividends received (eg from common stock, registered investment company shares)	2011-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-08-31	No
Was this plan covered by a fidelity bond	2011-08-31	Yes
Value of fidelity bond cover	2011-08-31	$500,000
If this is an individual account plan, was there a blackout period	2011-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-08-31	No
Contributions received from participants	2011-08-31	$299,207
Participant contributions at end of year	2011-08-31	$12,291
Participant contributions at beginning of year	2011-08-31	$11,521
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-08-31	$19
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-08-31	$19
Total non interest bearing cash at end of year	2011-08-31	$5,118
Total non interest bearing cash at beginning of year	2011-08-31	$12
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-08-31	No
Value of net income/loss	2011-08-31	$570,788
Value of net assets at end of year (total assets less liabilities)	2011-08-31	$7,879,357
Value of net assets at beginning of year (total assets less liabilities)	2011-08-31	$7,308,569
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-08-31	No
Were any leases to which the plan was party in default or uncollectible	2011-08-31	No
Interest earned on other investments	2011-08-31	$344,195
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-08-31	$352,591
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-08-31	$491,954
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-08-31	$491,954
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-08-31	$5,706
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-08-31	$7,503,301
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-08-31	$6,797,360
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-08-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-08-31	No
Has the plan failed to provide any benefit when due under the plan	2011-08-31	No
Contributions received in cash from employer	2011-08-31	$197,169
Employer contributions (assets) at end of year	2011-08-31	$6,037
Employer contributions (assets) at beginning of year	2011-08-31	$7,703
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-08-31	$275,489
Did the plan have assets held for investment	2011-08-31	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	2011-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-08-31	No
Opinion of an independent qualified public accountant for this plan	2011-08-31	Unqualified
Accountancy firm name	2011-08-31	THIBODEAUX, HEBERT, DESHOTELS, LEBL
Accountancy firm EIN	2011-08-31	208102502
2010 : HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-08-31	$0

Form 5500 Responses for HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN

2021: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Submission has been amended	No
2021-09-01	This submission is the final filing	No
2021-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-09-01	Plan is a collectively bargained plan	No
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan funding arrangement – Trust	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement - Trust	Yes
2020: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Submission has been amended	No
2020-09-01	This submission is the final filing	No
2020-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-09-01	Plan is a collectively bargained plan	No
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan funding arrangement – Trust	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement - Trust	Yes
2019: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Submission has been amended	No
2019-09-01	This submission is the final filing	No
2019-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-09-01	Plan is a collectively bargained plan	No
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan funding arrangement – Trust	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement - Trust	Yes
2018: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Submission has been amended	No
2018-09-01	This submission is the final filing	No
2018-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-09-01	Plan is a collectively bargained plan	No
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan funding arrangement – Trust	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement - Trust	Yes
2017: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Submission has been amended	No
2017-09-01	This submission is the final filing	No
2017-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-09-01	Plan is a collectively bargained plan	No
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan funding arrangement – Trust	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement - Trust	Yes
2016: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan funding arrangement – Trust	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement - Trust	Yes
2015: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan funding arrangement – Trust	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement - Trust	Yes
2014: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan funding arrangement – Trust	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement - Trust	Yes
2013: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	No
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan funding arrangement – Trust	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement - Trust	Yes
2012: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan funding arrangement – Trust	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement - Trust	Yes
2011: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan funding arrangement – Trust	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement - Trust	Yes
2009: HUB CITY FORD, INC. EMPLOYEES RETIREMENT PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Submission has been amended	No
2009-09-01	This submission is the final filing	No
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-09-01	Plan is a collectively bargained plan	No
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan funding arrangement – Trust	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	430339874
Policy instance	6
Insurance contract or identification number 430339874 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP:01574
Policy instance	4
Insurance contract or identification number ATMIP:01574 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06302
Policy instance	5
Insurance contract or identification number 3WS06302 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
OCEANVIEW LIFE & ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 68446 )
Policy contract number	HV00026572
Policy instance	13
Insurance contract or identification number HV00026572 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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 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
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000246054
Policy instance	7
Insurance contract or identification number 8000246054 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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 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
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP01914
Policy instance	8
Insurance contract or identification number ATMIP01914 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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 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
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06309
Policy instance	9
Insurance contract or identification number 3WS06309 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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 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
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000434464
Policy instance	10
Insurance contract or identification number 8000434464 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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 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
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	70023414
Policy instance	11
Insurance contract or identification number 70023414 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP08660
Policy instance	12
Insurance contract or identification number ATMIP08660 Number of Individuals Covered 140 Insurance policy start date 2021-09-01 Insurance policy end date 2022-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000151490
Policy instance	6
Insurance contract or identification number 8000151490 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	5
Insurance contract or identification number 14831234 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP:01574
Policy instance	4
Insurance contract or identification number ATMIP:01574 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06302
Policy instance	7
Insurance contract or identification number 3WS06302 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	430339874
Policy instance	8
Insurance contract or identification number 430339874 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	70023414
Policy instance	13
Insurance contract or identification number 70023414 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP08660
Policy instance	14
Insurance contract or identification number ATMIP08660 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000434464
Policy instance	12
Insurance contract or identification number 8000434464 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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 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
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06309
Policy instance	11
Insurance contract or identification number 3WS06309 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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 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
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP01914
Policy instance	10
Insurance contract or identification number ATMIP01914 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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 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
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000246054
Policy instance	9
Insurance contract or identification number 8000246054 Number of Individuals Covered 160 Insurance policy start date 2020-09-01 Insurance policy end date 2021-08-31 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 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
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP:01574
Policy instance	4
Insurance contract or identification number ATMIP:01574 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	5
Insurance contract or identification number 14831234 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000151490
Policy instance	6
Insurance contract or identification number 8000151490 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06302
Policy instance	7
Insurance contract or identification number 3WS06302 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A131476
Policy instance	8
Insurance contract or identification number 43A131476 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	430339874
Policy instance	9
Insurance contract or identification number 430339874 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP01914
Policy instance	11
Insurance contract or identification number ATMIP01914 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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 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
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06309
Policy instance	12
Insurance contract or identification number 3WS06309 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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 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
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000434464
Policy instance	13
Insurance contract or identification number 8000434464 Number of Individuals Covered 138 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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 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
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000246054
Policy instance	10
Insurance contract or identification number 8000246054 Number of Individuals Covered 138 Insurance policy start date 2019-09-01 Insurance policy end date 2020-08-31 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 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
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	6
Insurance contract or identification number 80000151490 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP:01574
Policy instance	4
Insurance contract or identification number ATMIP:01574 Number of Individuals Covered 125 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	5
Insurance contract or identification number 14831234 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06302
Policy instance	7
Insurance contract or identification number 3WS06302 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06309
Policy instance	12
Insurance contract or identification number 3WS06309 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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 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
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP01914
Policy instance	11
Insurance contract or identification number ATMIP01914 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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 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
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000246054
Policy instance	10
Insurance contract or identification number 8000246054 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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 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
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A131476
Policy instance	8
Insurance contract or identification number 43A131476 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	430339874
Policy instance	9
Insurance contract or identification number 430339874 Number of Individuals Covered 140 Insurance policy start date 2018-09-01 Insurance policy end date 2019-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	6
Insurance contract or identification number 80000151490 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06302
Policy instance	7
Insurance contract or identification number 3WS06302 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A131476
Policy instance	8
Insurance contract or identification number 43A131476 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	430339874
Policy instance	9
Insurance contract or identification number 430339874 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000246054
Policy instance	10
Insurance contract or identification number 8000246054 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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 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
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP01914
Policy instance	11
Insurance contract or identification number ATMIP01914 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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 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
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract number	3WS06309
Policy instance	12
Insurance contract or identification number 3WS06309 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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 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
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A104657
Policy instance	13
Insurance contract or identification number 43A104657 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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 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
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90289017
Policy instance	14
Insurance contract or identification number 90289017 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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 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
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	5
Insurance contract or identification number 14831234 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	ATMIP:01574
Policy instance	4
Insurance contract or identification number ATMIP:01574 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 125 Insurance policy start date 2017-09-01 Insurance policy end date 2018-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000246054
Policy instance	10
Insurance contract or identification number 8000246054 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	430339874
Policy instance	9
Insurance contract or identification number 430339874 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A131476
Policy instance	8
Insurance contract or identification number 43A131476 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A104657
Policy instance	7
Insurance contract or identification number 43A104657 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	6
Insurance contract or identification number 80000151490 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	5
Insurance contract or identification number 14831234 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90289017
Policy instance	4
Insurance contract or identification number 90289017 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 137 Insurance policy start date 2015-09-01 Insurance policy end date 2016-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	430339874
Policy instance	10
Insurance contract or identification number 430339874 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A131476
Policy instance	9
Insurance contract or identification number 43A131476 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A104657
Policy instance	8
Insurance contract or identification number 43A104657 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	7
Insurance contract or identification number 80000151490 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	5
Insurance contract or identification number 14831234 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90289017
Policy instance	4
Insurance contract or identification number 90289017 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	8000246054
Policy instance	11
Insurance contract or identification number 8000246054 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90343605
Policy instance	6
Insurance contract or identification number 90343605 Number of Individuals Covered 159 Insurance policy start date 2014-09-01 Insurance policy end date 2015-08-31 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	2
Insurance contract or identification number 21204239 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	3
Insurance contract or identification number 14803840 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90289017
Policy instance	4
Insurance contract or identification number 90289017 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	5
Insurance contract or identification number 14831234 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	7
Insurance contract or identification number 80000151490 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A104657
Policy instance	8
Insurance contract or identification number 43A104657 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A131476
Policy instance	9
Insurance contract or identification number 43A131476 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90343605
Policy instance	6
Insurance contract or identification number 90343605 Number of Individuals Covered 155 Insurance policy start date 2013-09-01 Insurance policy end date 2014-08-31 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	2
Insurance contract or identification number 80000151490 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A104657
Policy instance	3
Insurance contract or identification number 43A104657 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A131476
Policy instance	4
Insurance contract or identification number 43A131476 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	5
Insurance contract or identification number 21204239 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	6
Insurance contract or identification number 14803840 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90289017
Policy instance	7
Insurance contract or identification number 90289017 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90343605
Policy instance	9
Insurance contract or identification number 90343605 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	8
Insurance contract or identification number 14831234 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 146 Insurance policy start date 2012-09-01 Insurance policy end date 2013-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	2
Insurance contract or identification number 80000151490 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	5
Insurance contract or identification number 14803840 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90343605
Policy instance	8
Insurance contract or identification number 90343605 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	7
Insurance contract or identification number 14831234 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90289017
Policy instance	6
Insurance contract or identification number 90289017 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	4
Insurance contract or identification number 21204239 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A104657
Policy instance	3
Insurance contract or identification number 43A104657 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 130 Insurance policy start date 2011-09-01 Insurance policy end date 2012-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21198949
Policy instance	1
Insurance contract or identification number 21198949 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 66974 )
Policy contract number	80000151490
Policy instance	2
Insurance contract or identification number 80000151490 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GENWORTH FINANCIAL (National Association of Insurance Commissioners NAIC id number: 65536 )
Policy contract number	43A104657
Policy instance	3
Insurance contract or identification number 43A104657 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LINCOLN BENEFIT LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 65595 )
Policy contract number	LBF1081510
Policy instance	4
Insurance contract or identification number LBF1081510 Number of Individuals Covered 0 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14803840
Policy instance	8
Insurance contract or identification number 14803840 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14519300
Policy instance	5
Insurance contract or identification number 14519300 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )
Policy contract number	14831234
Policy instance	10
Insurance contract or identification number 14831234 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
JEFFERSON PILOT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 15955 )
Policy contract number	QP5307263
Policy instance	6
Insurance contract or identification number QP5307263 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90343605
Policy instance	11
Insurance contract or identification number 90343605 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLIANZ LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number	21204239
Policy instance	7
Insurance contract or identification number 21204239 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	90289017
Policy instance	9
Insurance contract or identification number 90289017 Number of Individuals Covered 124 Insurance policy start date 2010-09-01 Insurance policy end date 2011-08-31 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? Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No

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