401k Plan data: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN plan

MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 401k Plan overview

Plan Name	MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN
Plan identification number	501

MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MARCO DISPLAY SPECIALIST has sponsored the creation of one or more 401k plans.

Company Name: MARCO DISPLAY SPECIALIST

Employer identification number (EIN): 752050871

NAIC Classification: 326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-01-01 DARRELL LEE COOPER
501 2012-01-01 JON STEWART
501 2011-01-01 DARRELL LEE COOPER
501 2009-01-01 DARRELL LEE COOPER

Plan id#	Filing Submission Date	Name of Administrator
501	2012-01-01	DARRELL LEE COOPER
501	2012-01-01	JON STEWART
501	2011-01-01	DARRELL LEE COOPER
501	2009-01-01	DARRELL LEE COOPER

Plan Statistics for MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN

401k plan membership statisitcs for MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN

Measure Date Value
2012: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 520
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 140
Total of all active and inactive participants 2012-01-01 140
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
2011: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 474
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 520
Total of all active and inactive participants 2011-01-01 520
2009: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 181
Total of all active and inactive participants 2009-01-01 181

Measure	Date	Value
2012: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	520
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	140
Total of all active and inactive participants	2012-01-01	140
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
2011: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	474
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	520
Total of all active and inactive participants	2011-01-01	520
2009: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	181
Total of all active and inactive participants	2009-01-01	181

Form 5500 Responses for MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN

2012: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: MARCO DISPLAY SPECIALISTS LP EMPLOYEE INJURY BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

12492

Policy instance

Insurance contract or identification number	12492
Number of Individuals Covered	140
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $26,926
Total amount of fees paid to insurance company	USD $66,376
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $26,926
Amount paid for insurance broker fees	40876
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3

LEXINGTON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 19437 )

Policy contract number

4974758

Policy instance

Insurance contract or identification number	4974758
Number of Individuals Covered	0
Insurance policy start date	2011-12-31
Insurance policy end date	2012-12-30
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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	MARCO DISPLAY SPECIALIST
Employer identification number (EIN):	752050871
NAIC Classification:	326100