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FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 401k Plan overview

Plan NameFIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP
Plan identification number 001

FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP Benefits

401k Plan TypeDefined 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.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Stock bonus
  • 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.
  • ESOP other than a leveraged ESOP - A completed Schedule E must be attached to a Form 5500 filed for an Employee Stock Ownership Plan (ESOP).
  • The employer maintaining this ESOP is an S Corporation
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).
  • Plan requiring that all or part of employer contributions be invested and held, at least for a limited period, in employer securities.

401k Sponsoring company profile

FIRST NATIONAL BANK OF MOOSE LAKE has sponsored the creation of one or more 401k plans.

Company Name:FIRST NATIONAL BANK OF MOOSE LAKE
Employer identification number (EIN):410425123
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01LARRY PETERSON
0012017-01-01LARRY PETERSON
0012016-01-01LARRY PETERSON
0012015-01-01LARRY PETERSON
0012014-01-01LARRY PETERSON
0012013-01-01LARRY PETERSON
0012012-01-01LARRY PETERSON
0012011-01-01LARRY PETERSON
0012010-01-01LARRY PETERSON
0012009-01-01LARRY PETERSON LARRY PETERSON2010-05-12

Plan Statistics for FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP

401k plan membership statisitcs for FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP

Measure Date Value
2022: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2022 401k membership
Total participants, beginning-of-year2022-01-0139
Total number of active participants reported on line 7a of the Form 55002022-01-0125
Number of retired or separated participants receiving benefits2022-01-015
Number of other retired or separated participants entitled to future benefits2022-01-0111
Total of all active and inactive participants2022-01-0141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-011
Total participants2022-01-0142
Number of participants with account balances2022-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-012
2021: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2021 401k membership
Total participants, beginning-of-year2021-01-0140
Total number of active participants reported on line 7a of the Form 55002021-01-0126
Number of retired or separated participants receiving benefits2021-01-015
Number of other retired or separated participants entitled to future benefits2021-01-017
Total of all active and inactive participants2021-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-0139
Number of participants with account balances2021-01-0138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-012
2020: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2020 401k membership
Total participants, beginning-of-year2020-01-0137
Total number of active participants reported on line 7a of the Form 55002020-01-0127
Number of retired or separated participants receiving benefits2020-01-015
Number of other retired or separated participants entitled to future benefits2020-01-016
Total of all active and inactive participants2020-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0138
Number of participants with account balances2020-01-0138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2019 401k membership
Total participants, beginning-of-year2019-01-0140
Total number of active participants reported on line 7a of the Form 55002019-01-0127
Number of retired or separated participants receiving benefits2019-01-016
Number of other retired or separated participants entitled to future benefits2019-01-014
Total of all active and inactive participants2019-01-0137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0137
Number of participants with account balances2019-01-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2018 401k membership
Total participants, beginning-of-year2018-01-0136
Total number of active participants reported on line 7a of the Form 55002018-01-0125
Number of retired or separated participants receiving benefits2018-01-016
Number of other retired or separated participants entitled to future benefits2018-01-015
Total of all active and inactive participants2018-01-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0136
Number of participants with account balances2018-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2017 401k membership
Total participants, beginning-of-year2017-01-0131
Total number of active participants reported on line 7a of the Form 55002017-01-0122
Number of retired or separated participants receiving benefits2017-01-014
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0132
Number of participants with account balances2017-01-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2016 401k membership
Total participants, beginning-of-year2016-01-0132
Total number of active participants reported on line 7a of the Form 55002016-01-0118
Number of retired or separated participants receiving benefits2016-01-015
Number of other retired or separated participants entitled to future benefits2016-01-016
Total of all active and inactive participants2016-01-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0129
Number of participants with account balances2016-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-012
2015: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2015 401k membership
Total participants, beginning-of-year2015-01-0130
Total number of active participants reported on line 7a of the Form 55002015-01-0121
Number of retired or separated participants receiving benefits2015-01-014
Number of other retired or separated participants entitled to future benefits2015-01-017
Total of all active and inactive participants2015-01-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0132
Number of participants with account balances2015-01-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-012
2014: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2014 401k membership
Total participants, beginning-of-year2014-01-0129
Total number of active participants reported on line 7a of the Form 55002014-01-0121
Number of retired or separated participants receiving benefits2014-01-018
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0129
Number of participants with account balances2014-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2013 401k membership
Total participants, beginning-of-year2013-01-0129
Total number of active participants reported on line 7a of the Form 55002013-01-0120
Number of retired or separated participants receiving benefits2013-01-016
Number of other retired or separated participants entitled to future benefits2013-01-013
Total of all active and inactive participants2013-01-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0129
Number of participants with account balances2013-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-012
2012: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2012 401k membership
Total participants, beginning-of-year2012-01-0127
Total number of active participants reported on line 7a of the Form 55002012-01-0124
Number of retired or separated participants receiving benefits2012-01-015
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0129
Number of participants with account balances2012-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-011
2011: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2011 401k membership
Total participants, beginning-of-year2011-01-0128
Total number of active participants reported on line 7a of the Form 55002011-01-0121
Number of retired or separated participants receiving benefits2011-01-015
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0126
Number of participants with account balances2011-01-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2010 401k membership
Total participants, beginning-of-year2010-01-0128
Total number of active participants reported on line 7a of the Form 55002010-01-0125
Number of retired or separated participants receiving benefits2010-01-012
Number of other retired or separated participants entitled to future benefits2010-01-011
Total of all active and inactive participants2010-01-0128
Total participants2010-01-0128
Number of participants with account balances2010-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-011
2009: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2009 401k membership
Total participants, beginning-of-year2009-01-0128
Total number of active participants reported on line 7a of the Form 55002009-01-0124
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-012
Total of all active and inactive participants2009-01-0128
Total participants2009-01-0128
Number of participants with account balances2009-01-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011

Financial Data on FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP

Measure Date Value
2022 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2022 401k financial data
Total income from all sources2022-12-31$-1,426,482
Expenses. Total of all expenses incurred2022-12-31$559,932
Benefits paid (including direct rollovers)2022-12-31$558,776
Total plan assets at end of year2022-12-31$11,443,850
Total plan assets at beginning of year2022-12-31$13,430,264
Value of fidelity bond covering the plan2022-12-31$2,300,000
Total contributions received or receivable from participants2022-12-31$138,020
Other income received2022-12-31$-1,664,502
Net income (gross income less expenses)2022-12-31$-1,986,414
Net plan assets at end of year (total assets less liabilities)2022-12-31$11,443,850
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$13,430,264
Assets. Value of employer securities2022-12-31$6,475,120
Total contributions received or receivable from employer(s)2022-12-31$100,000
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$1,156
2021 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2021 401k financial data
Total income from all sources2021-12-31$1,854,572
Expenses. Total of all expenses incurred2021-12-31$119,437
Benefits paid (including direct rollovers)2021-12-31$118,477
Total plan assets at end of year2021-12-31$13,430,264
Total plan assets at beginning of year2021-12-31$11,695,129
Value of fidelity bond covering the plan2021-12-31$2,275,000
Total contributions received or receivable from participants2021-12-31$137,449
Other income received2021-12-31$1,607,123
Net income (gross income less expenses)2021-12-31$1,735,135
Net plan assets at end of year (total assets less liabilities)2021-12-31$13,430,264
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$11,695,129
Assets. Value of employer securities2021-12-31$7,179,588
Total contributions received or receivable from employer(s)2021-12-31$110,000
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$960
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2020 401k financial data
Total income from all sources2020-12-31$1,603,254
Expenses. Total of all expenses incurred2020-12-31$266,612
Benefits paid (including direct rollovers)2020-12-31$266,132
Total plan assets at end of year2020-12-31$11,695,129
Total plan assets at beginning of year2020-12-31$10,358,487
Value of fidelity bond covering the plan2020-12-31$2,275,000
Total contributions received or receivable from participants2020-12-31$104,705
Other income received2020-12-31$1,388,549
Net income (gross income less expenses)2020-12-31$1,336,642
Net plan assets at end of year (total assets less liabilities)2020-12-31$11,695,129
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$10,358,487
Assets. Value of employer securities2020-12-31$6,534,512
Total contributions received or receivable from employer(s)2020-12-31$110,000
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$480
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2019 401k financial data
Total income from all sources2019-12-31$1,747,580
Expenses. Total of all expenses incurred2019-12-31$236,867
Benefits paid (including direct rollovers)2019-12-31$235,787
Total plan assets at end of year2019-12-31$10,358,487
Total plan assets at beginning of year2019-12-31$8,847,774
Value of fidelity bond covering the plan2019-12-31$2,275,000
Total contributions received or receivable from participants2019-12-31$83,549
Other income received2019-12-31$1,559,031
Net income (gross income less expenses)2019-12-31$1,510,713
Net plan assets at end of year (total assets less liabilities)2019-12-31$10,358,487
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$8,847,774
Assets. Value of employer securities2019-12-31$6,176,652
Total contributions received or receivable from employer(s)2019-12-31$105,000
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$1,080
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2018 401k financial data
Total income from all sources2018-12-31$633,400
Expenses. Total of all expenses incurred2018-12-31$348,782
Benefits paid (including direct rollovers)2018-12-31$347,941
Total plan assets at end of year2018-12-31$8,847,774
Total plan assets at beginning of year2018-12-31$8,563,156
Value of fidelity bond covering the plan2018-12-31$1,050,000
Total contributions received or receivable from participants2018-12-31$91,705
Contributions received from other sources (not participants or employers)2018-12-31$12,050
Other income received2018-12-31$449,645
Net income (gross income less expenses)2018-12-31$284,618
Net plan assets at end of year (total assets less liabilities)2018-12-31$8,847,774
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$8,563,156
Assets. Value of employer securities2018-12-31$5,675,880
Total contributions received or receivable from employer(s)2018-12-31$80,000
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$841
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2017 401k financial data
Total income from all sources2017-12-31$1,240,284
Expenses. Total of all expenses incurred2017-12-31$810,817
Benefits paid (including direct rollovers)2017-12-31$810,295
Total plan assets at end of year2017-12-31$8,563,156
Total plan assets at beginning of year2017-12-31$8,133,689
Value of fidelity bond covering the plan2017-12-31$1,050,000
Total contributions received or receivable from participants2017-12-31$47,578
Other income received2017-12-31$1,102,706
Net income (gross income less expenses)2017-12-31$429,467
Net plan assets at end of year (total assets less liabilities)2017-12-31$8,563,156
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$8,133,689
Assets. Value of participant loans2017-12-31$8,908
Assets. Value of employer securities2017-12-31$5,135,088
Total contributions received or receivable from employer(s)2017-12-31$90,000
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$522
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2016 401k financial data
Total income from all sources2016-12-31$1,518,937
Expenses. Total of all expenses incurred2016-12-31$272,854
Benefits paid (including direct rollovers)2016-12-31$252,919
Total plan assets at end of year2016-12-31$8,133,689
Total plan assets at beginning of year2016-12-31$6,887,606
Value of fidelity bond covering the plan2016-12-31$1,050,000
Total contributions received or receivable from participants2016-12-31$52,433
Expenses. Other expenses not covered elsewhere2016-12-31$19,442
Contributions received from other sources (not participants or employers)2016-12-31$650,760
Other income received2016-12-31$745,744
Net income (gross income less expenses)2016-12-31$1,246,083
Net plan assets at end of year (total assets less liabilities)2016-12-31$8,133,689
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$6,887,606
Assets. Value of participant loans2016-12-31$11,268
Assets. Value of employer securities2016-12-31$4,752,172
Total contributions received or receivable from employer(s)2016-12-31$70,000
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$493
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2015 401k financial data
Total income from all sources2015-12-31$751,430
Expenses. Total of all expenses incurred2015-12-31$737,219
Benefits paid (including direct rollovers)2015-12-31$721,514
Total plan assets at end of year2015-12-31$6,887,606
Total plan assets at beginning of year2015-12-31$6,873,395
Value of fidelity bond covering the plan2015-12-31$1,050,000
Total contributions received or receivable from participants2015-12-31$66,137
Expenses. Other expenses not covered elsewhere2015-12-31$15,623
Other income received2015-12-31$610,293
Net income (gross income less expenses)2015-12-31$14,211
Net plan assets at end of year (total assets less liabilities)2015-12-31$6,887,606
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$6,873,395
Assets. Value of employer securities2015-12-31$4,440,480
Total contributions received or receivable from employer(s)2015-12-31$75,000
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$82
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$650,760
2014 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2014 401k financial data
Total income from all sources2014-12-31$701,385
Expenses. Total of all expenses incurred2014-12-31$672,965
Benefits paid (including direct rollovers)2014-12-31$672,185
Total plan assets at end of year2014-12-31$6,873,395
Total plan assets at beginning of year2014-12-31$6,844,975
Value of fidelity bond covering the plan2014-12-31$1,050,000
Total contributions received or receivable from participants2014-12-31$32,092
Other income received2014-12-31$594,293
Net income (gross income less expenses)2014-12-31$28,420
Net plan assets at end of year (total assets less liabilities)2014-12-31$6,873,395
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$6,844,975
Assets. Value of employer securities2014-12-31$4,653,670
Total contributions received or receivable from employer(s)2014-12-31$75,000
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$780
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2013 401k financial data
Total income from all sources2013-12-31$942,379
Expenses. Total of all expenses incurred2013-12-31$268,400
Benefits paid (including direct rollovers)2013-12-31$268,010
Total plan assets at end of year2013-12-31$6,844,975
Total plan assets at beginning of year2013-12-31$6,170,996
Value of fidelity bond covering the plan2013-12-31$1,050,000
Total contributions received or receivable from participants2013-12-31$39,369
Expenses. Other expenses not covered elsewhere2013-12-31$390
Contributions received from other sources (not participants or employers)2013-12-31$9,726
Other income received2013-12-31$818,284
Net income (gross income less expenses)2013-12-31$673,979
Net plan assets at end of year (total assets less liabilities)2013-12-31$6,844,975
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$6,170,996
Assets. Value of employer securities2013-12-31$4,378,360
Total contributions received or receivable from employer(s)2013-12-31$75,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2012 401k financial data
Total income from all sources2012-12-31$415,906
Expenses. Total of all expenses incurred2012-12-31$453,283
Benefits paid (including direct rollovers)2012-12-31$452,763
Total plan assets at end of year2012-12-31$6,170,996
Total plan assets at beginning of year2012-12-31$6,208,373
Value of fidelity bond covering the plan2012-12-31$700,000
Total contributions received or receivable from participants2012-12-31$43,867
Other income received2012-12-31$312,039
Net income (gross income less expenses)2012-12-31$-37,377
Net plan assets at end of year (total assets less liabilities)2012-12-31$6,170,996
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$6,208,373
Assets. Value of employer securities2012-12-31$4,358,640
Total contributions received or receivable from employer(s)2012-12-31$60,000
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$520
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2011 401k financial data
Total income from all sources2011-12-31$311,180
Expenses. Total of all expenses incurred2011-12-31$736,732
Benefits paid (including direct rollovers)2011-12-31$736,732
Total plan assets at end of year2011-12-31$6,208,373
Total plan assets at beginning of year2011-12-31$6,633,925
Value of fidelity bond covering the plan2011-12-31$700,000
Total contributions received or receivable from participants2011-12-31$42,365
Other income received2011-12-31$225,815
Net income (gross income less expenses)2011-12-31$-425,552
Net plan assets at end of year (total assets less liabilities)2011-12-31$6,208,373
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$6,633,925
Assets. Value of employer securities2011-12-31$4,528,920
Total contributions received or receivable from employer(s)2011-12-31$43,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2010 401k financial data
Total income from all sources2010-12-31$-50,956
Expenses. Total of all expenses incurred2010-12-31$569,922
Benefits paid (including direct rollovers)2010-12-31$569,922
Total plan assets at end of year2010-12-31$6,633,925
Total plan assets at beginning of year2010-12-31$7,254,803
Value of fidelity bond covering the plan2010-12-31$700,000
Total contributions received or receivable from participants2010-12-31$62,166
Other income received2010-12-31$-163,122
Net income (gross income less expenses)2010-12-31$-620,878
Net plan assets at end of year (total assets less liabilities)2010-12-31$6,633,925
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$7,254,803
Assets. Value of employer securities2010-12-31$4,437,632
Total contributions received or receivable from employer(s)2010-12-31$50,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP

2022: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: FIRST NATIONAL BANK OF MOOSE LAKE PROFIT SHARING AND ESOP 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number811955
Policy instance 1
Insurance contract or identification number811955
Number of Individuals Covered42
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $13,275
Total amount of fees paid to insurance companyUSD $700
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $13,275
Insurance broker organization code?3
Amount paid for insurance broker fees700
Additional information about fees paid to insurance brokerDISTRIBUTION FEES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number811955
Policy instance 1
Insurance contract or identification number811955
Number of Individuals Covered38
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,400
Total amount of fees paid to insurance companyUSD $100
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $14,400
Insurance broker organization code?3
Amount paid for insurance broker fees100
Additional information about fees paid to insurance brokerDISTRIBUTION FEES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number811955
Policy instance 1
Insurance contract or identification number811955
Number of Individuals Covered38
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $10,934
Total amount of fees paid to insurance companyUSD $150
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $10,934
Insurance broker organization code?3
Amount paid for insurance broker fees150
Additional information about fees paid to insurance brokerDISTRIBUTION FEES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number811955
Policy instance 1
Insurance contract or identification number811955
Number of Individuals Covered37
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,300
Total amount of fees paid to insurance companyUSD $450
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $9,300
Insurance broker organization code?3
Amount paid for insurance broker fees450
Additional information about fees paid to insurance brokerDISTRIBUTION FEES
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number811955
Policy instance 1
Insurance contract or identification number811955
Number of Individuals Covered36
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $8,630
Total amount of fees paid to insurance companyUSD $350
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $8,630
Insurance broker organization code?3
Amount paid for insurance broker fees350
Additional information about fees paid to insurance brokerDISTRIBUTION FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number45364
Policy instance 1
Insurance contract or identification number45364
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-26
Total amount of commissions paid to insurance brokerUSD $9,136
Total amount of fees paid to insurance companyUSD $500
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $9,136
Insurance broker organization code?3
Amount paid for insurance broker fees500
Additional information about fees paid to insurance brokerDISTRIBUTION/LOAN FEES
Insurance broker nameKJ RETIREMENT CONSULTANTS, LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number45364
Policy instance 1
Insurance contract or identification number45364
Number of Individuals Covered29
Insurance policy start date2016-01-01
Insurance policy end date2016-12-31
Total amount of commissions paid to insurance brokerUSD $8,841
Total amount of fees paid to insurance companyUSD $475
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $8,841
Insurance broker organization code?3
Amount paid for insurance broker fees475
Additional information about fees paid to insurance brokerDISTRIBUTION/LOAN FEES
Insurance broker nameKJ RETIREMENT CONSULTANTS, LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number453664
Policy instance 1
Insurance contract or identification number453664
Number of Individuals Covered32
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,425
Total amount of fees paid to insurance companyUSD $1,122
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $6,425
Insurance broker organization code?3
Amount paid for insurance broker fees1122
Additional information about fees paid to insurance brokerREVENUE SHARING
Insurance broker nameGOLDLEAF PARTNERS
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number45364
Policy instance 1
Insurance contract or identification number45364
Number of Individuals Covered29
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,388
Total amount of fees paid to insurance companyUSD $1,976
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $6,388
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUNIVERSAL RETIREMENT SOLUTIONS, INC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number45364
Policy instance 1
Insurance contract or identification number45364
Number of Individuals Covered29
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,237
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $5,772
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUNIVERSAL RETIREMENT SOLUTIONS, INC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number45364
Policy instance 1
Insurance contract or identification number45364
Number of Individuals Covered29
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $6,294
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $4,860
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUNIVERSAL RETIREMENT SOLUTIONS, INC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number45364
Policy instance 1
Insurance contract or identification number45364
Number of Individuals Covered26
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,322
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 number45364
Policy instance 1
Insurance contract or identification number45364
Number of Individuals Covered28
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,657
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $5,657
Insurance broker organization code?3
Insurance broker nameINVESTMENT CENTERS OF AMERICA

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