401k Plan data: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN plan

JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN
Plan identification number	001

JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

JAM GRAPHICS & DESIGN, LLC has sponsored the creation of one or more 401k plans.

Company Name: JAM GRAPHICS & DESIGN, LLC

Employer identification number (EIN): 810556971

NAIC Classification: 519100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JULIE MUELLER 2023-05-23
001 2021-01-01 JULIE MUELLER 2022-04-25
001 2019-01-01
001 2018-01-01 JULIE MUELLER
001 2017-01-01 JULIE MUELLER
001 2016-01-01 JULIE MUELLER
001 2015-01-01 JULIE MUELLER
001 2014-01-01 JULIE MUELLER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	JULIE MUELLER	2023-05-23
001	2021-01-01	JULIE MUELLER	2022-04-25
001	2019-01-01
001	2018-01-01	JULIE MUELLER
001	2017-01-01	JULIE MUELLER
001	2016-01-01	JULIE MUELLER
001	2015-01-01	JULIE MUELLER
001	2014-01-01	JULIE MUELLER

Plan Statistics for JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN

401k plan membership statisitcs for JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN

Measure Date Value
2019: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 2
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 2
Number of participants with account balances 2019-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 2
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 2
Number of participants with account balances 2018-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 1
Total of all active and inactive participants 2017-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 3
Number of participants with account balances 2017-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 3
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 3
Number of participants with account balances 2016-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 3
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 3
Number of participants with account balances 2015-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 3
Number of participants with account balances 2014-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2019: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	2
Number of participants with account balances	2019-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	2
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	2
Number of participants with account balances	2018-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	1
Total of all active and inactive participants	2017-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	3
Number of participants with account balances	2017-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	3
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	3
Number of participants with account balances	2016-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	3
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	3
Number of participants with account balances	2015-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	3
Number of participants with account balances	2014-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN

Measure	Date	Value
2019 : JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$217,744
Expenses. Total of all expenses incurred	2019-12-31	$431
Benefits paid (including direct rollovers)	2019-12-31	$0
Total plan assets at end of year	2019-12-31	$960,461
Total plan assets at beginning of year	2019-12-31	$743,148
Value of fidelity bond covering the plan	2019-12-31	$75,000
Total contributions received or receivable from participants	2019-12-31	$44,000
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$136,244
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$217,313
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$960,461
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$743,148
Total contributions received or receivable from employer(s)	2019-12-31	$37,500
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$431
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$31,699
Expenses. Total of all expenses incurred	2018-12-31	$24,141
Benefits paid (including direct rollovers)	2018-12-31	$23,996
Total plan assets at end of year	2018-12-31	$743,148
Total plan assets at beginning of year	2018-12-31	$735,590
Value of fidelity bond covering the plan	2018-12-31	$75,000
Total contributions received or receivable from participants	2018-12-31	$43,000
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-52,096
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$7,558
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$743,148
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$735,590
Total contributions received or receivable from employer(s)	2018-12-31	$40,795
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$145
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$186,745
Expenses. Total of all expenses incurred	2017-12-31	$0
Benefits paid (including direct rollovers)	2017-12-31	$0
Total plan assets at end of year	2017-12-31	$735,590
Total plan assets at beginning of year	2017-12-31	$548,845
Value of fidelity bond covering the plan	2017-12-31	$75,000
Total contributions received or receivable from participants	2017-12-31	$43,260
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$80,473
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$186,745
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$735,590
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$548,845
Total contributions received or receivable from employer(s)	2017-12-31	$63,012
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$143,516
Expenses. Total of all expenses incurred	2016-12-31	$0
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$548,845
Total plan assets at beginning of year	2016-12-31	$405,329
Value of fidelity bond covering the plan	2016-12-31	$50,000
Total contributions received or receivable from participants	2016-12-31	$43,881
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$36,489
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$143,516
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$548,845
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$405,329
Total contributions received or receivable from employer(s)	2016-12-31	$63,146
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$102,244
Expenses. Total of all expenses incurred	2015-12-31	$0
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$405,329
Total plan assets at beginning of year	2015-12-31	$303,085
Value of fidelity bond covering the plan	2015-12-31	$50,000
Total contributions received or receivable from participants	2015-12-31	$44,895
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-7,561
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$102,244
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$405,329
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$303,085
Total contributions received or receivable from employer(s)	2015-12-31	$64,910
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$83,997
Expenses. Total of all expenses incurred	2014-12-31	$405
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$303,085
Total plan assets at beginning of year	2014-12-31	$219,493
Total contributions received or receivable from participants	2014-12-31	$1,736
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$13,463
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$83,592
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$303,085
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$219,493
Total contributions received or receivable from employer(s)	2014-12-31	$68,798
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$405

Form 5500 Responses for JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN

2019: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: JAM GRAPHICS & DESIGN, LLC 401(K) RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

916676-01

Policy instance

Insurance contract or identification number	916676-01
Number of Individuals Covered	2
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,834
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,834
Insurance broker organization code?	7

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

Policy contract number

916676-01

Policy instance

Insurance contract or identification number	916676-01
Number of Individuals Covered	2
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,486
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,486
Insurance broker organization code?	7

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

Policy contract number

916676-01

Policy instance

Insurance contract or identification number	916676-01
Number of Individuals Covered	3
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,023
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,023
Insurance broker organization code?	7
Insurance broker name	ADAM SCHALLER / UBS FINANCIAL SVCS

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Company Name:	JAM GRAPHICS & DESIGN, LLC
Employer identification number (EIN):	810556971
NAIC Classification:	519100