401k Plan data: ALCYON, INC. RETIREMENT PLAN plan

ALCYON, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	ALCYON, INC. RETIREMENT PLAN
Plan identification number	001

ALCYON, INC. RETIREMENT 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.

401k Sponsoring company profile

ALCYON, INC. has sponsored the creation of one or more 401k plans.

Company Name: ALCYON, INC.

Employer identification number (EIN): 203525258

NAIC Classification: 624310
NAIC Description: Vocational Rehabilitation Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALCYON, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01 PATRICIA WATSON PATRICIA WATSON 2019-07-22
001 2017-01-01 REAGAN TOMLINSON REAGAN TOMLINSON 2018-10-12
001 2016-01-01 LETOSHA SCRUGGS
001 2015-01-01 VALERIE SANDERS
001 2014-01-01 VALERIE SANDERS 2015-07-14
001 2013-01-01 AUTUMN SELLARS FRANCIS 2014-06-19
001 2012-01-01 AUTUMN SELLARS FRANCIS
001 2011-01-01 CAROLYN BARNETT AUTUMN SELLARS FRANCIS 2012-07-10
001 2009-01-01 AUTUMN SELLARS FRANCIS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2018-01-01	PATRICIA WATSON		PATRICIA WATSON	2019-07-22
001	2017-01-01	REAGAN TOMLINSON		REAGAN TOMLINSON	2018-10-12
001	2016-01-01	LETOSHA SCRUGGS
001	2015-01-01	VALERIE SANDERS
001	2014-01-01	VALERIE SANDERS	2015-07-14
001	2013-01-01	AUTUMN SELLARS FRANCIS	2014-06-19
001	2012-01-01	AUTUMN SELLARS FRANCIS
001	2011-01-01	CAROLYN BARNETT		AUTUMN SELLARS FRANCIS	2012-07-10
001	2009-01-01	AUTUMN SELLARS FRANCIS

Plan Statistics for ALCYON, INC. RETIREMENT PLAN

401k plan membership statisitcs for ALCYON, INC. RETIREMENT PLAN

Measure Date Value
2018: ALCYON, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 0
Number of participants with account balances 2018-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: ALCYON, INC. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 96
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 83
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 36
Total of all active and inactive participants 2017-01-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 120
Number of participants with account balances 2017-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: ALCYON, INC. RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 70
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 26
Total of all active and inactive participants 2016-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 96
Number of participants with account balances 2016-01-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ALCYON, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 79
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 88
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 14
Total of all active and inactive participants 2015-01-01 103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 103
Number of participants with account balances 2015-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2012: ALCYON, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 25
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 4
Total of all active and inactive participants 2012-01-01 29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 29
Number of participants with account balances 2012-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: ALCYON, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 18
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 2
Total of all active and inactive participants 2011-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 20
Number of participants with account balances 2011-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: ALCYON, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
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 2
Total of all active and inactive participants 2009-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 9
Number of participants with account balances 2009-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2018: ALCYON, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	0
Number of participants with account balances	2018-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: ALCYON, INC. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	96
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	83
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	36
Total of all active and inactive participants	2017-01-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	120
Number of participants with account balances	2017-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: ALCYON, INC. RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	70
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	26
Total of all active and inactive participants	2016-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	96
Number of participants with account balances	2016-01-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ALCYON, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	79
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	88
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	14
Total of all active and inactive participants	2015-01-01	103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	103
Number of participants with account balances	2015-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2012: ALCYON, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	25
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	4
Total of all active and inactive participants	2012-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	29
Number of participants with account balances	2012-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: ALCYON, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	18
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	2
Total of all active and inactive participants	2011-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	20
Number of participants with account balances	2011-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: ALCYON, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
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	2
Total of all active and inactive participants	2009-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	9
Number of participants with account balances	2009-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on ALCYON, INC. RETIREMENT PLAN

Measure	Date	Value
2018 : ALCYON, INC. RETIREMENT PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-07	$-2,583,228
Total income from all sources	2018-12-07	$320,017
Expenses. Total of all expenses incurred	2018-12-07	$1,073,764
Benefits paid (including direct rollovers)	2018-12-07	$1,073,764
Total plan assets at end of year	2018-12-07	$0
Total plan assets at beginning of year	2018-12-07	$3,336,975
Value of fidelity bond covering the plan	2018-12-07	$250,000
Total contributions received or receivable from participants	2018-12-07	$275,254
Other income received	2018-12-07	$-91,769
Net income (gross income less expenses)	2018-12-07	$-753,747
Net plan assets at end of year (total assets less liabilities)	2018-12-07	$0
Net plan assets at beginning of year (total assets less liabilities)	2018-12-07	$3,336,975
Total contributions received or receivable from employer(s)	2018-12-07	$136,532
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-07	$0
2017 : ALCYON, INC. RETIREMENT PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$1,228,959
Expenses. Total of all expenses incurred	2017-12-31	$191,156
Benefits paid (including direct rollovers)	2017-12-31	$191,156
Total plan assets at end of year	2017-12-31	$3,336,975
Total plan assets at beginning of year	2017-12-31	$2,299,172
Value of fidelity bond covering the plan	2017-12-31	$250,000
Total contributions received or receivable from participants	2017-12-31	$376,117
Contributions received from other sources (not participants or employers)	2017-12-31	$272,892
Other income received	2017-12-31	$406,046
Net income (gross income less expenses)	2017-12-31	$1,037,803
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$3,336,975
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$2,299,172
Assets. Value of participant loans	2017-12-31	$94,111
Total contributions received or receivable from employer(s)	2017-12-31	$173,904
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : ALCYON, INC. RETIREMENT PLAN 2016 401k financial data
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$878,556
Expenses. Total of all expenses incurred	2016-12-31	$115,193
Benefits paid (including direct rollovers)	2016-12-31	$115,193
Total plan assets at end of year	2016-12-31	$2,299,172
Total plan assets at beginning of year	2016-12-31	$1,535,809
Value of fidelity bond covering the plan	2016-12-31	$250,000
Total contributions received or receivable from participants	2016-12-31	$388,535
Contributions received from other sources (not participants or employers)	2016-12-31	$168,259
Other income received	2016-12-31	$161,473
Net income (gross income less expenses)	2016-12-31	$763,363
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,299,172
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,535,809
Assets. Value of participant loans	2016-12-31	$92,985
Total contributions received or receivable from employer(s)	2016-12-31	$160,289
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : ALCYON, INC. RETIREMENT PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$1,211,621
Expenses. Total of all expenses incurred	2015-12-31	$616,864
Benefits paid (including direct rollovers)	2015-12-31	$616,864
Total plan assets at end of year	2015-12-31	$1,535,809
Total plan assets at beginning of year	2015-12-31	$941,052
Value of fidelity bond covering the plan	2015-12-31	$250,000
Total contributions received or receivable from participants	2015-12-31	$498,450
Contributions received from other sources (not participants or employers)	2015-12-31	$649,951
Other income received	2015-12-31	$-49,565
Net income (gross income less expenses)	2015-12-31	$594,757
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,535,809
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$941,052
Assets. Value of participant loans	2015-12-31	$70,327
Total contributions received or receivable from employer(s)	2015-12-31	$112,785
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2012 : ALCYON, INC. RETIREMENT PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$436
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$140,496
Expenses. Total of all expenses incurred	2012-12-31	$36,720
Benefits paid (including direct rollovers)	2012-12-31	$36,720
Total plan assets at end of year	2012-12-31	$417,375
Total plan assets at beginning of year	2012-12-31	$313,163
Value of fidelity bond covering the plan	2012-12-31	$250,000
Total contributions received or receivable from participants	2012-12-31	$76,904
Other income received	2012-12-31	$41,127
Net income (gross income less expenses)	2012-12-31	$103,776
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$416,939
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$313,163
Assets. Value of participant loans	2012-12-31	$61,303
Total contributions received or receivable from employer(s)	2012-12-31	$22,465
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : ALCYON, INC. RETIREMENT PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$161,341
Expenses. Total of all expenses incurred	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$313,163
Total plan assets at beginning of year	2011-12-31	$151,822
Value of fidelity bond covering the plan	2011-12-31	$20,000
Total contributions received or receivable from participants	2011-12-31	$40,018
Contributions received from other sources (not participants or employers)	2011-12-31	$110,322
Other income received	2011-12-31	$-6,998
Net income (gross income less expenses)	2011-12-31	$161,341
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$313,163
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$151,822
Assets. Value of participant loans	2011-12-31	$62,742
Total contributions received or receivable from employer(s)	2011-12-31	$17,999
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : ALCYON, INC. RETIREMENT PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$81,766
Expenses. Total of all expenses incurred	2010-12-31	$29,817
Benefits paid (including direct rollovers)	2010-12-31	$29,817
Total plan assets at end of year	2010-12-31	$151,822
Total plan assets at beginning of year	2010-12-31	$99,873
Value of fidelity bond covering the plan	2010-12-31	$10,000
Total contributions received or receivable from participants	2010-12-31	$27,582
Contributions received from other sources (not participants or employers)	2010-12-31	$26,986
Other income received	2010-12-31	$12,589
Net income (gross income less expenses)	2010-12-31	$51,949
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$151,822
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$99,873
Total contributions received or receivable from employer(s)	2010-12-31	$14,609
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : ALCYON, INC. RETIREMENT 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 ALCYON, INC. RETIREMENT PLAN

2018: ALCYON, INC. 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	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: ALCYON, INC. 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: ALCYON, INC. 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: ALCYON, INC. 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
2012: ALCYON, INC. RETIREMENT 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: ALCYON, INC. RETIREMENT 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: ALCYON, INC. RETIREMENT 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 – Trust	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

109155

Policy instance

Insurance contract or identification number	109155
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-07
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,705
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5705
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5

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

Policy contract number

109155

Policy instance

Insurance contract or identification number	109155
Number of Individuals Covered	122
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,821
Total amount of fees paid to insurance company	USD $1,625
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,754
Insurance broker organization code?	3
Amount paid for insurance broker fees	1625
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	FINANCIAL CONSULTING GROUP

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

Policy contract number

109155

Policy instance

Insurance contract or identification number	109155
Number of Individuals Covered	110
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,533
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,050
Insurance broker organization code?	5
Insurance broker name	SOUTHEASTERN EMPLOYEE BENEFIT

Potentially related plans

ALCYON, INC. [EIN = 203255258]

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Company Name:	ALCYON, INC.
Employer identification number (EIN):	203525258
NAIC Classification:	624310
NAIC Description:	Vocational Rehabilitation Services