401k Plan data: MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN plan

MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 401k Plan overview

Plan Name	MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN
Plan identification number	005

MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

MCGRIFF, SEIBELS & WILLIAMS, INC. has sponsored the creation of one or more 401k plans.

Company Name: MCGRIFF, SEIBELS & WILLIAMS, INC.

Employer identification number (EIN): 200468966

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Additional information about MCGRIFF, SEIBELS & WILLIAMS, INC.

Jurisdiction of Incorporation: Alabama Secretary of State

Incorporation Date: 2003-12-08

Company Identification Number: 232-372

Legal Registered Office Address: 2 NORTH JACKSON ST., SUITE 605 MONTGOMERY,

United States of America (USA)
36104

More information about MCGRIFF, SEIBELS & WILLIAMS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
005 2012-01-01 THOMAS LAMBERT
005 2011-01-01 THOMAS LAMBERT
005 2009-01-01 THOMAS A. LAMBERT, III THOMAS A . LAMBERT, III 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
005	2012-01-01	THOMAS LAMBERT
005	2011-01-01	THOMAS LAMBERT
005	2009-01-01	THOMAS A. LAMBERT, III	THOMAS A . LAMBERT, III	2010-10-14

Plan Statistics for MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN

401k plan membership statisitcs for MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN

Measure Date Value
2012: MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 845
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 640
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 145
Total of all active and inactive participants 2012-01-01 785
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 785
Number of participants with account balances 2012-01-01 761
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 850
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 666
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 128
Total of all active and inactive participants 2011-01-01 794
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 794
Number of participants with account balances 2011-01-01 768
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 877
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 690
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 115
Total of all active and inactive participants 2009-01-01 805
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 805
Number of participants with account balances 2009-01-01 760
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	845
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	640
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	145
Total of all active and inactive participants	2012-01-01	785
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	785
Number of participants with account balances	2012-01-01	761
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	850
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	666
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	128
Total of all active and inactive participants	2011-01-01	794
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	794
Number of participants with account balances	2011-01-01	768
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	877
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	690
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	115
Total of all active and inactive participants	2009-01-01	805
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	805
Number of participants with account balances	2009-01-01	760
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN

Measure	Date	Value
2012 : MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$8,923
Total income from all sources (including contributions)	2012-12-31	$16,029,800
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$5,646,378
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$5,615,500
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$8,477,890
Value of total assets at end of year	2012-12-31	$70,567,275
Value of total assets at beginning of year	2012-12-31	$60,192,776
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$30,878
Total interest from all sources	2012-12-31	$76,275
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$25,730
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$25,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$5,107,698
Participant contributions at end of year	2012-12-31	$1,423,877
Participant contributions at beginning of year	2012-12-31	$1,362,684
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$597,210
Administrative expenses (other) incurred	2012-12-31	$5,148
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$10,383,422
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$70,567,275
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$60,183,853
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$65,189,390
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$55,188,515
Interest on participant loans	2012-12-31	$70,821
Interest earned on other investments	2012-12-31	$5,454
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$1,181,026
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$936,059
Net investment gain/loss from pooled separate accounts	2012-12-31	$7,475,635
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$2,772,982
Employer contributions (assets) at end of year	2012-12-31	$2,772,982
Employer contributions (assets) at beginning of year	2012-12-31	$2,705,518
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$5,615,500
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$8,923
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	L. PAUL KASSOUF & CO., P.C.
Accountancy firm EIN	2012-12-31	630590670
2011 : MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$8,923
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$6,024,477
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$2,851,257
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$2,809,914
Expenses. Certain deemed distributions of participant loans	2011-12-31	$755
Value of total corrective distributions	2011-12-31	$3,851
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$7,833,531
Value of total assets at end of year	2011-12-31	$60,192,776
Value of total assets at beginning of year	2011-12-31	$57,010,633
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$36,737
Total interest from all sources	2011-12-31	$68,651
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$33,365
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$25,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$4,994,340
Participant contributions at end of year	2011-12-31	$1,362,684
Participant contributions at beginning of year	2011-12-31	$978,730
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$133,673
Administrative expenses (other) incurred	2011-12-31	$3,372
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$3,173,220
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$60,183,853
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$57,010,633
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$55,188,515
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$52,343,103
Interest on participant loans	2011-12-31	$61,551
Interest earned on other investments	2011-12-31	$7,100
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$936,059
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$979,004
Net investment gain/loss from pooled separate accounts	2011-12-31	$-1,877,705
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$2,705,518
Employer contributions (assets) at end of year	2011-12-31	$2,705,518
Employer contributions (assets) at beginning of year	2011-12-31	$2,709,796
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$2,809,914
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$8,923
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	L. PAUL KASSOUF & CO., P.C.
Accountancy firm EIN	2011-12-31	630590670
2010 : MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$13,848,769
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$3,286,927
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$3,246,457
Expenses. Certain deemed distributions of participant loans	2010-12-31	$9,490
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$7,809,533
Value of total assets at end of year	2010-12-31	$57,010,633
Value of total assets at beginning of year	2010-12-31	$46,448,791
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$30,980
Total interest from all sources	2010-12-31	$64,769
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$28,295
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$25,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$5,026,965
Participant contributions at end of year	2010-12-31	$978,730
Participant contributions at beginning of year	2010-12-31	$822,896
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$72,723
Administrative expenses (other) incurred	2010-12-31	$2,685
Total non interest bearing cash at end of year	2010-12-31	$0
Total non interest bearing cash at beginning of year	2010-12-31	$17
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$10,561,842
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$57,010,633
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$46,448,791
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$52,343,103
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$42,042,730
Interest on participant loans	2010-12-31	$47,086
Interest earned on other investments	2010-12-31	$17,683
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$979,004
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$764,674
Net investment gain/loss from pooled separate accounts	2010-12-31	$5,974,467
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$2,709,845
Employer contributions (assets) at end of year	2010-12-31	$2,709,796
Employer contributions (assets) at beginning of year	2010-12-31	$2,818,474
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$3,246,457
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	L. PAUL KASSOUF & CP., P.C.
Accountancy firm EIN	2010-12-31	630590670
2009 : MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN

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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

71454

Policy instance

Insurance contract or identification number	71454
Number of Individuals Covered	930
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $118,382
Total amount of fees paid to insurance company	USD $38,256
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?	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 $118,382
Insurance broker organization code?	3
Amount paid for insurance broker fees	31671
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker name	BENEFITS ADMINISTRATION SERVICES

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

71454

Policy instance

Insurance contract or identification number	71454
Number of Individuals Covered	912
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $141,415
Total amount of fees paid to insurance company	USD $28,882
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?	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

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

71454

Policy instance

Insurance contract or identification number	71454
Number of Individuals Covered	909
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $118,824
Total amount of fees paid to insurance company	USD $23,525
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?	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 $118,824
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Amount paid for insurance broker fees	23425
Insurance broker name	BENEFITS ADMINISTRATION SERVICES218

Potentially related plans

MCGRIFF, SEIBELS & WILLIAMS, INC. EMPLOYEE 401(K) PLAN [EIN = 560939887]

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Company Name:	MCGRIFF, SEIBELS & WILLIAMS, INC.
Employer identification number (EIN):	200468966
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages

Jurisdiction of Incorporation:	Alabama Secretary of State
Incorporation Date:	2003-12-08
Company Identification Number:	232-372
Legal Registered Office Address:	2 NORTH JACKSON ST., SUITE 605 MONTGOMERY, United States of America (USA) 36104