401k Plan data: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN plan

PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN
Plan identification number	001

PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

PRAIRIE STATE IMPRESSIONS, LLC has sponsored the creation of one or more 401k plans.

Company Name: PRAIRIE STATE IMPRESSIONS, LLC

Employer identification number (EIN): 364302150

NAIC Classification: 323100

Additional information about PRAIRIE STATE IMPRESSIONS, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3042134

More information about PRAIRIE STATE IMPRESSIONS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 GRAHAM REDDING 2023-11-10 GRAHAM REDDING 2023-11-10
001 2022-01-01 GRAHAM REDDING 2023-10-16 GRAHAM REDDING 2023-10-16
001 2021-01-01 IRENE ZHU 2022-10-14 IRENE ZHU 2022-10-14
001 2020-01-01 DANIEL DOHERTY 2021-07-20 DANIEL DOHERTY 2021-07-20
001 2020-01-01 DANIEL DOHERTY 2021-07-20 DANIEL DOHERTY 2021-07-20
001 2019-01-01
001 2018-01-01
001 2017-01-01 RICHARD HEINZEN RICHARD HEINZEN 2018-08-15
001 2016-01-01 RICHARD HEINZEN RICHARD HEINZEN 2017-07-20
001 2015-01-01 RICHARD HEINZEN RICHARD HEINZEN 2016-09-19
001 2014-01-01 RICHARD HEINZEN RICHARD HEINZEN 2015-09-28
001 2013-01-01 SAMDRA NELSON SAMDRA NELSON 2014-09-05
001 2012-01-01 SANDRA NELSON SANDRA NELSON 2013-09-16
001 2011-01-01 RICHARD HEINZEN RICHARD HEINZEN 2012-07-19
001 2009-01-01 RICHARD HEINZEN RICHARD HEINZEN 2010-09-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01	GRAHAM REDDING	2023-11-10	GRAHAM REDDING	2023-11-10
001	2022-01-01	GRAHAM REDDING	2023-10-16	GRAHAM REDDING	2023-10-16
001	2021-01-01	IRENE ZHU	2022-10-14	IRENE ZHU	2022-10-14
001	2020-01-01	DANIEL DOHERTY	2021-07-20	DANIEL DOHERTY	2021-07-20
001	2020-01-01	DANIEL DOHERTY	2021-07-20	DANIEL DOHERTY	2021-07-20
001	2019-01-01
001	2018-01-01
001	2017-01-01	RICHARD HEINZEN		RICHARD HEINZEN	2018-08-15
001	2016-01-01	RICHARD HEINZEN		RICHARD HEINZEN	2017-07-20
001	2015-01-01	RICHARD HEINZEN		RICHARD HEINZEN	2016-09-19
001	2014-01-01	RICHARD HEINZEN		RICHARD HEINZEN	2015-09-28
001	2013-01-01	SAMDRA NELSON		SAMDRA NELSON	2014-09-05
001	2012-01-01	SANDRA NELSON		SANDRA NELSON	2013-09-16
001	2011-01-01	RICHARD HEINZEN		RICHARD HEINZEN	2012-07-19
001	2009-01-01	RICHARD HEINZEN		RICHARD HEINZEN	2010-09-29

Financial Data on PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2022 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total expenses incurred by plan in this plan year	2022-10-14	393353
Net assets as of the end of the plan year	2022-10-14	3649323
Total assets as of the beginning of the plan year	2022-10-14	3298800
Participant contributions to plan in this plan year	2022-10-14	290260
Value of participant loans at end of plan year	2022-10-14	148432
Other contributions to plan in this plan year	2022-10-14	23438
Other income to plan in this plan year	2022-10-14	391187
Plan net income in this plan year	2022-10-14	350523
Net assets as of the end of the plan year	2022-10-14	3649323
Net assets as of the beginning of the plan year	2022-10-14	3298800
Value of contributions failed to transmitted timely	2022-10-14	26662
Employer contributions to plan in this plan year	2022-10-14	38991
Fees paid to broker by Benefit Provider	2022-10-14	1654
Expensese paid to adminstrative service provicers from plan in this plan year	2022-10-14	12699
2019 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$623,886
Expenses. Total of all expenses incurred	2019-12-31	$105,140
Benefits paid (including direct rollovers)	2019-12-31	$94,182
Total plan assets at end of year	2019-12-31	$2,933,862
Total plan assets at beginning of year	2019-12-31	$2,415,116
Value of fidelity bond covering the plan	2019-12-31	$300,000
Total contributions received or receivable from participants	2019-12-31	$173,811
Other income received	2019-12-31	$426,460
Net income (gross income less expenses)	2019-12-31	$518,746
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$2,933,862
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,415,116
Assets. Value of participant loans	2019-12-31	$171,609
Total contributions received or receivable from employer(s)	2019-12-31	$23,615
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$10,958
2018 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$65,456
Expenses. Total of all expenses incurred	2018-12-31	$206,772
Benefits paid (including direct rollovers)	2018-12-31	$196,571
Total plan assets at end of year	2018-12-31	$2,415,116
Total plan assets at beginning of year	2018-12-31	$2,556,432
Value of fidelity bond covering the plan	2018-12-31	$300,000
Total contributions received or receivable from participants	2018-12-31	$168,849
Other income received	2018-12-31	$-103,393
Net income (gross income less expenses)	2018-12-31	$-141,316
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,415,116
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$2,556,432
Assets. Value of participant loans	2018-12-31	$167,599
Total contributions received or receivable from employer(s)	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$10,201
2017 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$458,723
Expenses. Total of all expenses incurred	2017-12-31	$181,397
Benefits paid (including direct rollovers)	2017-12-31	$171,302
Total plan assets at end of year	2017-12-31	$2,556,432
Total plan assets at beginning of year	2017-12-31	$2,279,106
Value of fidelity bond covering the plan	2017-12-31	$300,000
Total contributions received or receivable from participants	2017-12-31	$162,639
Other income received	2017-12-31	$296,084
Net income (gross income less expenses)	2017-12-31	$277,326
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$2,556,432
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$2,279,106
Assets. Value of participant loans	2017-12-31	$125,860
Total contributions received or receivable from employer(s)	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$10,095
2016 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$361,749
Expenses. Total of all expenses incurred	2016-12-31	$56,900
Benefits paid (including direct rollovers)	2016-12-31	$45,296
Total plan assets at end of year	2016-12-31	$2,279,106
Total plan assets at beginning of year	2016-12-31	$1,974,257
Value of fidelity bond covering the plan	2016-12-31	$300,000
Total contributions received or receivable from participants	2016-12-31	$166,368
Contributions received from other sources (not participants or employers)	2016-12-31	$20,000
Other income received	2016-12-31	$161,452
Net income (gross income less expenses)	2016-12-31	$304,849
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,279,106
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,974,257
Assets. Value of participant loans	2016-12-31	$172,898
Total contributions received or receivable from employer(s)	2016-12-31	$13,929
Value of certain deemed distributions of participant loans	2016-12-31	$635
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$10,969
2015 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$1,164,469
Total income from all sources	2015-12-31	$67,341
Expenses. Total of all expenses incurred	2015-12-31	$37,759
Benefits paid (including direct rollovers)	2015-12-31	$26,676
Total plan assets at end of year	2015-12-31	$1,974,257
Total plan assets at beginning of year	2015-12-31	$780,206
Value of fidelity bond covering the plan	2015-12-31	$195,000
Total contributions received or receivable from participants	2015-12-31	$83,609
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-40,262
Net income (gross income less expenses)	2015-12-31	$29,582
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,974,257
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$780,206
Assets. Value of participant loans	2015-12-31	$23,993
Total contributions received or receivable from employer(s)	2015-12-31	$23,994
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$11,083
2014 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$251,065
Expenses. Total of all expenses incurred	2014-12-31	$213,920
Benefits paid (including direct rollovers)	2014-12-31	$204,636
Total plan assets at end of year	2014-12-31	$780,206
Total plan assets at beginning of year	2014-12-31	$743,061
Value of fidelity bond covering the plan	2014-12-31	$195,000
Total contributions received or receivable from participants	2014-12-31	$81,682
Contributions received from other sources (not participants or employers)	2014-12-31	$121,091
Other income received	2014-12-31	$32,514
Net income (gross income less expenses)	2014-12-31	$37,145
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$780,206
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$743,061
Assets. Value of participant loans	2014-12-31	$98,419
Total contributions received or receivable from employer(s)	2014-12-31	$15,778
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$9,284
2013 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$208,864
Expenses. Total of all expenses incurred	2013-12-31	$20,066
Benefits paid (including direct rollovers)	2013-12-31	$11,901
Total plan assets at end of year	2013-12-31	$743,061
Total plan assets at beginning of year	2013-12-31	$554,263
Value of fidelity bond covering the plan	2013-12-31	$195,000
Total contributions received or receivable from participants	2013-12-31	$82,984
Contributions received from other sources (not participants or employers)	2013-12-31	$28,139
Other income received	2013-12-31	$77,741
Net income (gross income less expenses)	2013-12-31	$188,798
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$743,061
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$554,263
Assets. Value of participant loans	2013-12-31	$53,222
Total contributions received or receivable from employer(s)	2013-12-31	$20,000
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$8,165
2012 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$272,337
Expenses. Total of all expenses incurred	2012-12-31	$6,269
Benefits paid (including direct rollovers)	2012-12-31	$351
Total plan assets at end of year	2012-12-31	$554,263
Total plan assets at beginning of year	2012-12-31	$288,195
Value of fidelity bond covering the plan	2012-12-31	$195,000
Total contributions received or receivable from participants	2012-12-31	$44,900
Contributions received from other sources (not participants or employers)	2012-12-31	$135,249
Other income received	2012-12-31	$42,188
Net income (gross income less expenses)	2012-12-31	$266,068
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$554,263
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$288,195
Assets. Value of participant loans	2012-12-31	$17,247
Total contributions received or receivable from employer(s)	2012-12-31	$50,000
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$5,918
2011 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$223,585
Expenses. Total of all expenses incurred	2011-12-31	$237,867
Benefits paid (including direct rollovers)	2011-12-31	$232,784
Total plan assets at end of year	2011-12-31	$288,195
Total plan assets at beginning of year	2011-12-31	$302,477
Value of fidelity bond covering the plan	2011-12-31	$195,000
Total contributions received or receivable from participants	2011-12-31	$31,935
Expenses. Other expenses not covered elsewhere	2011-12-31	$5,083
Contributions received from other sources (not participants or employers)	2011-12-31	$180,097
Other income received	2011-12-31	$-18,277
Net income (gross income less expenses)	2011-12-31	$-14,282
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$288,195
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$302,477
Assets. Value of participant loans	2011-12-31	$7,465
Total contributions received or receivable from employer(s)	2011-12-31	$29,830
2010 : PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$68,713
Expenses. Total of all expenses incurred	2010-12-31	$17,801
Benefits paid (including direct rollovers)	2010-12-31	$13,697
Total plan assets at end of year	2010-12-31	$302,477
Total plan assets at beginning of year	2010-12-31	$251,565
Value of fidelity bond covering the plan	2010-12-31	$195,000
Total contributions received or receivable from participants	2010-12-31	$24,399
Expenses. Other expenses not covered elsewhere	2010-12-31	$4,104
Contributions received from other sources (not participants or employers)	2010-12-31	$3,709
Other income received	2010-12-31	$25,728
Net income (gross income less expenses)	2010-12-31	$50,912
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$302,477
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$251,565
Assets. Value of participant loans	2010-12-31	$9,327
Total contributions received or receivable from employer(s)	2010-12-31	$14,877

Form 5500 Responses for PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN

2019: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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
2013: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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: PRAIRIE STATE IMPRESSIONS, LLC 401(K) PROFIT SHARING 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 - 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	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	30626
Policy instance	1

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Company Name:	PRAIRIE STATE IMPRESSIONS, LLC
Employer identification number (EIN):	364302150
NAIC Classification:	323100

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3042134