401k Plan data: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN plan

VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN
Plan identification number	001

VALLEY ISLE PUMPING, INC. PROFIT SHARING 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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

VALLEY ISLE PUMPING, INC. has sponsored the creation of one or more 401k plans.

Company Name: VALLEY ISLE PUMPING, INC.

Employer identification number (EIN): 990203030

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-11-01 PATRICIA MARINO 2023-02-04
001 2020-11-01 PATRICIA MARINO 2022-02-21
001 2019-11-01 PATRICIA MARINO 2021-03-21
001 2018-11-01 PATRICIA MARINO 2020-04-10
001 2017-11-01 PATRICIA MARINO 2019-02-24
001 2016-11-01 PATRICIA MARINO 2018-02-13
001 2015-11-01 PATRICIA MARINO
001 2014-11-01 PATRICIA MARINO
001 2013-11-01 PATRICIA MARINO
001 2012-11-01 PATRICIA MARINO
001 2011-11-01 PATRICIA MARINO
001 2010-11-01 PATRICIA MARINO 2012-01-27
001 2009-11-01 PATRICIA MARINO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2021-11-01	PATRICIA MARINO	2023-02-04
001	2020-11-01	PATRICIA MARINO	2022-02-21
001	2019-11-01	PATRICIA MARINO	2021-03-21
001	2018-11-01	PATRICIA MARINO	2020-04-10
001	2017-11-01	PATRICIA MARINO	2019-02-24
001	2016-11-01	PATRICIA MARINO	2018-02-13
001	2015-11-01	PATRICIA MARINO
001	2014-11-01	PATRICIA MARINO
001	2013-11-01	PATRICIA MARINO
001	2012-11-01	PATRICIA MARINO
001	2011-11-01	PATRICIA MARINO
001	2010-11-01	PATRICIA MARINO	2012-01-27
001	2009-11-01	PATRICIA MARINO

Plan Statistics for VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN

Measure Date Value
2015: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-11-01 13
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 9
Number of retired or separated participants receiving benefits 2015-11-01 0
Number of other retired or separated participants entitled to future benefits 2015-11-01 2
Total of all active and inactive participants 2015-11-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-11-01 0
Total participants 2015-11-01 11
Number of participants with account balances 2015-11-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-11-01 2
2014: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-11-01 13
Total number of active participants reported on line 7a of the Form 5500 2014-11-01 10
Number of retired or separated participants receiving benefits 2014-11-01 0
Number of other retired or separated participants entitled to future benefits 2014-11-01 2
Total of all active and inactive participants 2014-11-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-11-01 0
Total participants 2014-11-01 12
Number of participants with account balances 2014-11-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-11-01 0
2013: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-11-01 11
Total number of active participants reported on line 7a of the Form 5500 2013-11-01 9
Number of retired or separated participants receiving benefits 2013-11-01 0
Number of other retired or separated participants entitled to future benefits 2013-11-01 2
Total of all active and inactive participants 2013-11-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-11-01 0
Total participants 2013-11-01 11
Number of participants with account balances 2013-11-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-11-01 0
2012: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-11-01 11
Total number of active participants reported on line 7a of the Form 5500 2012-11-01 9
Number of retired or separated participants receiving benefits 2012-11-01 0
Number of other retired or separated participants entitled to future benefits 2012-11-01 1
Total of all active and inactive participants 2012-11-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-11-01 0
Total participants 2012-11-01 10
Number of participants with account balances 2012-11-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-11-01 0
2011: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-11-01 12
Total number of active participants reported on line 7a of the Form 5500 2011-11-01 9
Number of retired or separated participants receiving benefits 2011-11-01 0
Number of other retired or separated participants entitled to future benefits 2011-11-01 2
Total of all active and inactive participants 2011-11-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-11-01 0
Total participants 2011-11-01 11
Number of participants with account balances 2011-11-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-11-01 0
2009: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-11-01 11
Total number of active participants reported on line 7a of the Form 5500 2009-11-01 10
Number of retired or separated participants receiving benefits 2009-11-01 0
Number of other retired or separated participants entitled to future benefits 2009-11-01 0
Total of all active and inactive participants 2009-11-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-11-01 0
Total participants 2009-11-01 10
Number of participants with account balances 2009-11-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-11-01 1

Measure	Date	Value
2015: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-11-01	13
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	9
Number of retired or separated participants receiving benefits	2015-11-01	0
Number of other retired or separated participants entitled to future benefits	2015-11-01	2
Total of all active and inactive participants	2015-11-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-11-01	0
Total participants	2015-11-01	11
Number of participants with account balances	2015-11-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-11-01	2
2014: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-11-01	13
Total number of active participants reported on line 7a of the Form 5500	2014-11-01	10
Number of retired or separated participants receiving benefits	2014-11-01	0
Number of other retired or separated participants entitled to future benefits	2014-11-01	2
Total of all active and inactive participants	2014-11-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-11-01	0
Total participants	2014-11-01	12
Number of participants with account balances	2014-11-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-11-01	0
2013: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-11-01	11
Total number of active participants reported on line 7a of the Form 5500	2013-11-01	9
Number of retired or separated participants receiving benefits	2013-11-01	0
Number of other retired or separated participants entitled to future benefits	2013-11-01	2
Total of all active and inactive participants	2013-11-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-11-01	0
Total participants	2013-11-01	11
Number of participants with account balances	2013-11-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-11-01	0
2012: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-11-01	11
Total number of active participants reported on line 7a of the Form 5500	2012-11-01	9
Number of retired or separated participants receiving benefits	2012-11-01	0
Number of other retired or separated participants entitled to future benefits	2012-11-01	1
Total of all active and inactive participants	2012-11-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-11-01	0
Total participants	2012-11-01	10
Number of participants with account balances	2012-11-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-11-01	0
2011: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-11-01	12
Total number of active participants reported on line 7a of the Form 5500	2011-11-01	9
Number of retired or separated participants receiving benefits	2011-11-01	0
Number of other retired or separated participants entitled to future benefits	2011-11-01	2
Total of all active and inactive participants	2011-11-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-11-01	0
Total participants	2011-11-01	11
Number of participants with account balances	2011-11-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-11-01	0
2009: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-11-01	11
Total number of active participants reported on line 7a of the Form 5500	2009-11-01	10
Number of retired or separated participants receiving benefits	2009-11-01	0
Number of other retired or separated participants entitled to future benefits	2009-11-01	0
Total of all active and inactive participants	2009-11-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-11-01	0
Total participants	2009-11-01	10
Number of participants with account balances	2009-11-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-11-01	1

Financial Data on VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN

Measure	Date	Value
2016 : VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-10-31	$0
Total plan liabilities at end of year	2016-10-31	$0
Total plan liabilities at beginning of year	2016-10-31	$0
Total income from all sources	2016-10-31	$34,516
Expenses. Total of all expenses incurred	2016-10-31	$14,483
Benefits paid (including direct rollovers)	2016-10-31	$13,883
Total plan assets at end of year	2016-10-31	$240,622
Total plan assets at beginning of year	2016-10-31	$220,589
Value of fidelity bond covering the plan	2016-10-31	$200,000
Total contributions received or receivable from participants	2016-10-31	$0
Expenses. Other expenses not covered elsewhere	2016-10-31	$199
Contributions received from other sources (not participants or employers)	2016-10-31	$0
Other income received	2016-10-31	$-12,059
Noncash contributions received	2016-10-31	$0
Net income (gross income less expenses)	2016-10-31	$20,033
Net plan assets at end of year (total assets less liabilities)	2016-10-31	$240,622
Net plan assets at beginning of year (total assets less liabilities)	2016-10-31	$220,589
Assets. Value of assets in partnership/joint-venture interests	2016-10-31	$0
Total contributions received or receivable from employer(s)	2016-10-31	$46,575
Value of corrective distributions	2016-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-10-31	$401
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-10-31	$0
2015 : VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-10-31	$0
Total plan liabilities at end of year	2015-10-31	$0
Total plan liabilities at beginning of year	2015-10-31	$0
Total income from all sources	2015-10-31	$30,186
Expenses. Total of all expenses incurred	2015-10-31	$396
Benefits paid (including direct rollovers)	2015-10-31	$0
Total plan assets at end of year	2015-10-31	$220,589
Total plan assets at beginning of year	2015-10-31	$190,799
Value of fidelity bond covering the plan	2015-10-31	$200,000
Total contributions received or receivable from participants	2015-10-31	$0
Expenses. Other expenses not covered elsewhere	2015-10-31	$0
Contributions received from other sources (not participants or employers)	2015-10-31	$0
Other income received	2015-10-31	$1,196
Noncash contributions received	2015-10-31	$0
Net income (gross income less expenses)	2015-10-31	$29,790
Net plan assets at end of year (total assets less liabilities)	2015-10-31	$220,589
Net plan assets at beginning of year (total assets less liabilities)	2015-10-31	$190,799
Assets. Value of assets in partnership/joint-venture interests	2015-10-31	$14,611
Total contributions received or receivable from employer(s)	2015-10-31	$28,990
Value of certain deemed distributions of participant loans	2015-10-31	$0
Value of corrective distributions	2015-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-10-31	$396
2014 : VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan	2014-10-31	$0
Total plan liabilities at end of year	2014-10-31	$0
Total plan liabilities at beginning of year	2014-10-31	$0
Total income from all sources	2014-10-31	$34,346
Expenses. Total of all expenses incurred	2014-10-31	$373
Benefits paid (including direct rollovers)	2014-10-31	$0
Total plan assets at end of year	2014-10-31	$190,799
Total plan assets at beginning of year	2014-10-31	$156,826
Value of fidelity bond covering the plan	2014-10-31	$200,000
Total contributions received or receivable from participants	2014-10-31	$0
Expenses. Other expenses not covered elsewhere	2014-10-31	$0
Contributions received from other sources (not participants or employers)	2014-10-31	$0
Other income received	2014-10-31	$10,830
Noncash contributions received	2014-10-31	$0
Net income (gross income less expenses)	2014-10-31	$33,973
Net plan assets at end of year (total assets less liabilities)	2014-10-31	$190,799
Net plan assets at beginning of year (total assets less liabilities)	2014-10-31	$156,826
Assets. Value of real-estate (other than employer real property)	2014-10-31	$14,611
Total contributions received or receivable from employer(s)	2014-10-31	$23,516
Value of certain deemed distributions of participant loans	2014-10-31	$0
Value of corrective distributions	2014-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-10-31	$373
2013 : VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-10-31	$0
Total plan liabilities at end of year	2013-10-31	$0
Total plan liabilities at beginning of year	2013-10-31	$0
Total income from all sources	2013-10-31	$65,055
Expenses. Total of all expenses incurred	2013-10-31	$50,530
Benefits paid (including direct rollovers)	2013-10-31	$49,987
Total plan assets at end of year	2013-10-31	$156,826
Total plan assets at beginning of year	2013-10-31	$142,301
Value of fidelity bond covering the plan	2013-10-31	$200,000
Total contributions received or receivable from participants	2013-10-31	$0
Expenses. Other expenses not covered elsewhere	2013-10-31	$178
Contributions received from other sources (not participants or employers)	2013-10-31	$0
Other income received	2013-10-31	$16,039
Noncash contributions received	2013-10-31	$0
Net income (gross income less expenses)	2013-10-31	$14,525
Net plan assets at end of year (total assets less liabilities)	2013-10-31	$156,826
Net plan assets at beginning of year (total assets less liabilities)	2013-10-31	$142,301
Total contributions received or receivable from employer(s)	2013-10-31	$49,016
Value of certain deemed distributions of participant loans	2013-10-31	$0
Value of corrective distributions	2013-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-10-31	$365
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-10-31	$0
2012 : VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-10-31	$0
Total plan liabilities at end of year	2012-10-31	$0
Total plan liabilities at beginning of year	2012-10-31	$0
Total income from all sources	2012-10-31	$-14,468
Expenses. Total of all expenses incurred	2012-10-31	$451,389
Benefits paid (including direct rollovers)	2012-10-31	$449,681
Total plan assets at end of year	2012-10-31	$142,301
Total plan assets at beginning of year	2012-10-31	$608,158
Value of fidelity bond covering the plan	2012-10-31	$200,000
Total contributions received or receivable from participants	2012-10-31	$0
Expenses. Other expenses not covered elsewhere	2012-10-31	$1,341
Contributions received from other sources (not participants or employers)	2012-10-31	$0
Other income received	2012-10-31	$-14,468
Noncash contributions received	2012-10-31	$0
Net income (gross income less expenses)	2012-10-31	$-465,857
Net plan assets at end of year (total assets less liabilities)	2012-10-31	$142,301
Net plan assets at beginning of year (total assets less liabilities)	2012-10-31	$608,158
Total contributions received or receivable from employer(s)	2012-10-31	$0
Value of certain deemed distributions of participant loans	2012-10-31	$0
Value of corrective distributions	2012-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-10-31	$367
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-10-31	$0
2010 : VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-10-31	$0

Form 5500 Responses for VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN

2015: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-11-01	Type of plan entity	Single employer plan
2015-11-01	Submission has been amended	No
2015-11-01	This submission is the final filing	No
2015-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-11-01	Plan is a collectively bargained plan	No
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan funding arrangement – Trust	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement - Trust	Yes
2014: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-11-01	Type of plan entity	Single employer plan
2014-11-01	Submission has been amended	No
2014-11-01	This submission is the final filing	No
2014-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-11-01	Plan is a collectively bargained plan	No
2014-11-01	Plan funding arrangement – Insurance	Yes
2014-11-01	Plan funding arrangement – Trust	Yes
2014-11-01	Plan benefit arrangement – Insurance	Yes
2014-11-01	Plan benefit arrangement - Trust	Yes
2013: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-11-01	Type of plan entity	Single employer plan
2013-11-01	Submission has been amended	No
2013-11-01	This submission is the final filing	No
2013-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-11-01	Plan is a collectively bargained plan	No
2013-11-01	Plan funding arrangement – Insurance	Yes
2013-11-01	Plan funding arrangement – Trust	Yes
2013-11-01	Plan benefit arrangement – Insurance	Yes
2013-11-01	Plan benefit arrangement - Trust	Yes
2012: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-11-01	Type of plan entity	Single employer plan
2012-11-01	Submission has been amended	No
2012-11-01	This submission is the final filing	No
2012-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-11-01	Plan is a collectively bargained plan	No
2012-11-01	Plan funding arrangement – Insurance	Yes
2012-11-01	Plan funding arrangement – Trust	Yes
2012-11-01	Plan benefit arrangement – Insurance	Yes
2012-11-01	Plan benefit arrangement - Trust	Yes
2011: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-11-01	Type of plan entity	Single employer plan
2011-11-01	Submission has been amended	No
2011-11-01	This submission is the final filing	No
2011-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-11-01	Plan is a collectively bargained plan	No
2011-11-01	Plan funding arrangement – Insurance	Yes
2011-11-01	Plan funding arrangement – Trust	Yes
2011-11-01	Plan benefit arrangement – Insurance	Yes
2011-11-01	Plan benefit arrangement - Trust	Yes
2009: VALLEY ISLE PUMPING, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-11-01	Type of plan entity	Single employer plan
2009-11-01	Submission has been amended	No
2009-11-01	This submission is the final filing	No
2009-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-11-01	Plan is a collectively bargained plan	No
2009-11-01	Plan funding arrangement – Insurance	Yes
2009-11-01	Plan funding arrangement – Trust	Yes
2009-11-01	Plan benefit arrangement – Insurance	Yes
2009-11-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GAP-54-U749

Policy instance

Insurance contract or identification number	GAP-54-U749
Insurance policy start date	2015-11-01
Insurance policy end date	2016-10-31
Total amount of commissions paid to insurance broker	USD $1,113
Total amount of fees paid to insurance company	USD $278
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Amount paid for insurance broker fees	278
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $1,113
Insurance broker name	BANKOH INVESTMENT SERVICES, IN

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

Policy contract number

GAP-54-U749

Policy instance

Insurance contract or identification number	GAP-54-U749
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $1,032
Total amount of fees paid to insurance company	USD $258
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	258
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	BANKOH INVESTMENT SERVICES, IN

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

Policy contract number

GAP-54-U749

Policy instance

Insurance contract or identification number	GAP-54-U749
Number of Individuals Covered	11
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $734
Total amount of fees paid to insurance company	USD $184
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Amount paid for insurance broker fees	184
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $734
Insurance broker name	BANKOH INVESTMENT SERVICES, IN

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

Policy contract number

GAP-54-U749

Policy instance

Insurance contract or identification number	GAP-54-U749
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $1,836
Total amount of fees paid to insurance company	USD $459
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Amount paid for insurance broker fees	459
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $1,836
Insurance broker name	FSC SECURITIES CORP

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

Policy contract number

GAP-54-U749

Policy instance

Insurance contract or identification number	GAP-54-U749
Number of Individuals Covered	8
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $1,154
Total amount of fees paid to insurance company	USD $289
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes

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Company Name:	VALLEY ISLE PUMPING, INC.
Employer identification number (EIN):	990203030
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services