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GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameGYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number 001

GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

GYM SOURCE USA, LLC has sponsored the creation of one or more 401k plans.

Company Name:GYM SOURCE USA, LLC
Employer identification number (EIN):132931776
NAIC Classification:452900

Additional information about GYM SOURCE USA, LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2013-12-04
Company Identification Number: 0801893119
Legal Registered Office Address: PO BOX 424

STOCKTON
United States of America (USA)
08559

More information about GYM SOURCE USA, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012014-01-01LEE LICHTENSTEIN
0012013-01-01LEE LICHTENSTEIN
0012012-01-01CUTLER OWENS INTERNATIONAL LTD
0012011-01-01RICHARD MILLER
0012010-01-01RICHARD MILLER
0012009-01-01RICHARD MILLER

Plan Statistics for GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2014: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-01179
Total number of active participants reported on line 7a of the Form 55002014-01-01159
Number of retired or separated participants receiving benefits2014-01-017
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01166
Number of participants with account balances2014-01-0175
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-01190
Total number of active participants reported on line 7a of the Form 55002013-01-01167
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-018
Total of all active and inactive participants2013-01-01175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-011
Total participants2013-01-01176
Number of participants with account balances2013-01-0173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-01172
Total number of active participants reported on line 7a of the Form 55002012-01-01185
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-015
Total of all active and inactive participants2012-01-01190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01190
Number of participants with account balances2012-01-0169
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-015
2011: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-01161
Total number of active participants reported on line 7a of the Form 55002011-01-01163
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-019
Total of all active and inactive participants2011-01-01172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01172
Number of participants with account balances2011-01-0167
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-017
2010: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-01166
Total number of active participants reported on line 7a of the Form 55002010-01-01150
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0110
Total of all active and inactive participants2010-01-01160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01160
Number of participants with account balances2010-01-0163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-0115
2009: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-01174
Total number of active participants reported on line 7a of the Form 55002009-01-01156
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0110
Total of all active and inactive participants2009-01-01166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01166
Number of participants with account balances2009-01-0161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-0126

Financial Data on GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2014 : GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$72,409
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$72,409
Total income from all sources (including contributions)2014-12-31$988,767
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$259,056
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$221,900
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$652,627
Value of total assets at end of year2014-12-31$5,303,814
Value of total assets at beginning of year2014-12-31$4,574,103
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$37,156
Total interest from all sources2014-12-31$10,118
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$434,184
Participant contributions at end of year2014-12-31$251,228
Participant contributions at beginning of year2014-12-31$195,225
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$72,409
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$72,409
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$729,711
Value of net assets at end of year (total assets less liabilities)2014-12-31$5,231,405
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$4,501,694
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$5,052,586
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$4,378,878
Value of interest in pooled separate accounts at end of year2014-12-31$0
Value of interest in pooled separate accounts at beginning of year2014-12-31$0
Interest on participant loans2014-12-31$10,118
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$326,022
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$218,443
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$221,900
Contract administrator fees2014-12-31$37,156
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31Yes
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31LBMC, PC
Accountancy firm EIN2014-12-31621199757
2013 : GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$72,409
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$67,502
Total income from all sources (including contributions)2013-12-31$1,120,273
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$261,357
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$257,607
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$539,922
Value of total assets at end of year2013-12-31$4,574,103
Value of total assets at beginning of year2013-12-31$3,710,280
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$3,750
Total interest from all sources2013-12-31$7,266
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$344,676
Participant contributions at end of year2013-12-31$195,225
Participant contributions at beginning of year2013-12-31$120,465
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$37,411
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$72,409
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$67,502
Other income not declared elsewhere2013-12-31$82,848
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$858,916
Value of net assets at end of year (total assets less liabilities)2013-12-31$4,501,694
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$3,642,778
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$4,378,878
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$0
Value of interest in pooled separate accounts at end of year2013-12-31$0
Value of interest in pooled separate accounts at beginning of year2013-12-31$2,808,884
Interest on participant loans2013-12-31$7,266
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$780,931
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$27,487
Net investment gain/loss from pooled separate accounts2013-12-31$462,750
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$157,835
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$257,607
Contract administrator fees2013-12-31$3,750
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31Yes
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31WARREN AVERETT, LLC
Accountancy firm EIN2013-12-31454084437
2012 : GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets2012-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$0
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total transfer of assets to this plan2012-12-31$0
Total transfer of assets from this plan2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$67,502
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$60,316
Expenses. Interest paid2012-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022012-12-31$0
Total income from all sources (including contributions)2012-12-31$858,324
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$450,393
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$384,817
Expenses. Certain deemed distributions of participant loans2012-12-31$0
Value of total corrective distributions2012-12-31$62,994
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$623,801
Value of total assets at end of year2012-12-31$3,710,280
Value of total assets at beginning of year2012-12-31$3,295,163
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$2,582
Total income from rents2012-12-31$0
Total interest from all sources2012-12-31$23,550
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Assets. Real estate other than employer real property at beginning of year2012-12-31$0
Administrative expenses professional fees incurred2012-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2012-12-31$0
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$299,594
Participant contributions at end of year2012-12-31$120,465
Participant contributions at beginning of year2012-12-31$136,994
Participant contributions at beginning of year2012-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$156,489
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$0
Assets. Loans (other than to participants) at beginning of year2012-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$67,502
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$60,316
Other income not declared elsewhere2012-12-31$0
Administrative expenses (other) incurred2012-12-31$2,582
Liabilities. Value of operating payables at beginning of year2012-12-31$0
Total non interest bearing cash at beginning of year2012-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Income. Non cash contributions2012-12-31$0
Value of net income/loss2012-12-31$407,931
Value of net assets at end of year (total assets less liabilities)2012-12-31$3,642,778
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$3,234,847
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Assets. partnership/joint venture interests at beginning of year2012-12-31$0
Investment advisory and management fees2012-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$0
Value of interest in pooled separate accounts at end of year2012-12-31$2,808,884
Value of interest in pooled separate accounts at beginning of year2012-12-31$1,733,712
Interest on participant loans2012-12-31$5,147
Income. Interest from loans (other than to participants)2012-12-31$0
Interest earned on other investments2012-12-31$18,403
Income. Interest from US Government securities2012-12-31$0
Income. Interest from corporate debt instruments2012-12-31$0
Value of interest in master investment trust accounts at beginning of year2012-12-31$0
Value of interest in common/collective trusts at beginning of year2012-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2012-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$780,931
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$1,424,457
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$0
Asset value of US Government securities at beginning of year2012-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$210,973
Net investment gain/loss from pooled separate accounts2012-12-31$0
Net investment gain or loss from common/collective trusts2012-12-31$0
Net gain/loss from 103.12 investment entities2012-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Assets. Invements in employer securities at beginning of year2012-12-31$0
Assets. Value of employer real property at beginning of year2012-12-31$0
Contributions received in cash from employer2012-12-31$167,718
Employer contributions (assets) at beginning of year2012-12-31$0
Income. Dividends from preferred stock2012-12-31$0
Income. Dividends from common stock2012-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$384,817
Asset. Corporate debt instrument preferred debt at beginning of year2012-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2012-12-31$0
Contract administrator fees2012-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2012-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-12-31$0
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$0
Aggregate carrying amount (costs) on sale of assets2012-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2012-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31COHN REZNICK LLP
Accountancy firm EIN2012-12-31221478099
2011 : GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets2011-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$0
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total transfer of assets to this plan2011-12-31$0
Total transfer of assets from this plan2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Expenses. Interest paid2011-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022011-12-31$0
Total income from all sources (including contributions)2011-12-31$445,722
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$68,926
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$4,128
Expenses. Certain deemed distributions of participant loans2011-12-31$0
Value of total corrective distributions2011-12-31$61,918
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$484,774
Value of total assets at end of year2011-12-31$3,295,163
Value of total assets at beginning of year2011-12-31$2,918,367
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$2,880
Total income from rents2011-12-31$0
Total interest from all sources2011-12-31$31,020
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Assets. Real estate other than employer real property at end of year2011-12-31$0
Assets. Real estate other than employer real property at beginning of year2011-12-31$0
Administrative expenses professional fees incurred2011-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2011-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2011-12-31$0
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$326,092
Participant contributions at end of year2011-12-31$136,994
Participant contributions at beginning of year2011-12-31$98,185
Participant contributions at end of year2011-12-31$0
Participant contributions at beginning of year2011-12-31$0
Assets. Other investments not covered elsewhere at end of year2011-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$0
Assets. Loans (other than to participants) at end of year2011-12-31$0
Assets. Loans (other than to participants) at beginning of year2011-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$0
Other income not declared elsewhere2011-12-31$0
Administrative expenses (other) incurred2011-12-31$0
Total non interest bearing cash at end of year2011-12-31$0
Total non interest bearing cash at beginning of year2011-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Income. Non cash contributions2011-12-31$0
Value of net income/loss2011-12-31$376,796
Value of net assets at end of year (total assets less liabilities)2011-12-31$3,295,163
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$2,918,367
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Assets. partnership/joint venture interests at end of year2011-12-31$0
Assets. partnership/joint venture interests at beginning of year2011-12-31$0
Investment advisory and management fees2011-12-31$2,405
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$0
Value of interest in pooled separate accounts at end of year2011-12-31$1,733,712
Value of interest in pooled separate accounts at beginning of year2011-12-31$1,644,789
Interest on participant loans2011-12-31$4,842
Income. Interest from loans (other than to participants)2011-12-31$0
Interest earned on other investments2011-12-31$26,178
Income. Interest from US Government securities2011-12-31$0
Income. Interest from corporate debt instruments2011-12-31$0
Value of interest in master investment trust accounts at end of year2011-12-31$0
Value of interest in master investment trust accounts at beginning of year2011-12-31$0
Value of interest in common/collective trusts at end of year2011-12-31$0
Value of interest in common/collective trusts at beginning of year2011-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2011-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2011-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$1,424,457
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$1,175,393
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$0
Asset value of US Government securities at end of year2011-12-31$0
Asset value of US Government securities at beginning of year2011-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$0
Net investment gain/loss from pooled separate accounts2011-12-31$-70,072
Net investment gain or loss from common/collective trusts2011-12-31$0
Net gain/loss from 103.12 investment entities2011-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Assets. Invements in employer securities at end of year2011-12-31$0
Assets. Invements in employer securities at beginning of year2011-12-31$0
Assets. Value of employer real property at end of year2011-12-31$0
Assets. Value of employer real property at beginning of year2011-12-31$0
Contributions received in cash from employer2011-12-31$158,682
Employer contributions (assets) at end of year2011-12-31$0
Employer contributions (assets) at beginning of year2011-12-31$0
Income. Dividends from preferred stock2011-12-31$0
Income. Dividends from common stock2011-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$4,128
Asset. Corporate debt instrument preferred debt at end of year2011-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2011-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2011-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2011-12-31$0
Contract administrator fees2011-12-31$475
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$0
Liabilities. Value of benefit claims payable at end of year2011-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2011-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-12-31$0
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$0
Aggregate carrying amount (costs) on sale of assets2011-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2011-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2011-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31ROSEN SEYMOUR SHAPSS MARTIN & CO LL
Accountancy firm EIN2011-12-31135653927
2010 : GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets2010-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$0
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total transfer of assets to this plan2010-12-31$0
Total transfer of assets from this plan2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Expenses. Interest paid2010-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022010-12-31$0
Total income from all sources (including contributions)2010-12-31$669,620
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$86,741
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$53,582
Expenses. Certain deemed distributions of participant loans2010-12-31$0
Value of total corrective distributions2010-12-31$30,681
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$469,370
Value of total assets at end of year2010-12-31$2,918,367
Value of total assets at beginning of year2010-12-31$2,335,488
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$2,478
Total income from rents2010-12-31$0
Total interest from all sources2010-12-31$19,935
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$0
Assets. Real estate other than employer real property at end of year2010-12-31$0
Assets. Real estate other than employer real property at beginning of year2010-12-31$0
Administrative expenses professional fees incurred2010-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2010-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2010-12-31$0
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$321,776
Participant contributions at end of year2010-12-31$98,185
Participant contributions at beginning of year2010-12-31$57,688
Participant contributions at end of year2010-12-31$0
Participant contributions at beginning of year2010-12-31$0
Assets. Other investments not covered elsewhere at end of year2010-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$0
Assets. Loans (other than to participants) at end of year2010-12-31$0
Assets. Loans (other than to participants) at beginning of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$0
Other income not declared elsewhere2010-12-31$0
Administrative expenses (other) incurred2010-12-31$0
Total non interest bearing cash at end of year2010-12-31$0
Total non interest bearing cash at beginning of year2010-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Income. Non cash contributions2010-12-31$0
Value of net income/loss2010-12-31$582,879
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,918,367
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,335,488
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Assets. partnership/joint venture interests at end of year2010-12-31$0
Assets. partnership/joint venture interests at beginning of year2010-12-31$0
Investment advisory and management fees2010-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$0
Value of interest in pooled separate accounts at end of year2010-12-31$1,644,789
Value of interest in pooled separate accounts at beginning of year2010-12-31$2,235,959
Interest on participant loans2010-12-31$3,526
Income. Interest from loans (other than to participants)2010-12-31$0
Interest earned on other investments2010-12-31$16,409
Income. Interest from US Government securities2010-12-31$0
Income. Interest from corporate debt instruments2010-12-31$0
Value of interest in master investment trust accounts at end of year2010-12-31$0
Value of interest in master investment trust accounts at beginning of year2010-12-31$0
Value of interest in common/collective trusts at end of year2010-12-31$0
Value of interest in common/collective trusts at beginning of year2010-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2010-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$1,175,393
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$41,841
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$0
Asset value of US Government securities at end of year2010-12-31$0
Asset value of US Government securities at beginning of year2010-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$0
Net investment gain/loss from pooled separate accounts2010-12-31$180,315
Net investment gain or loss from common/collective trusts2010-12-31$0
Net gain/loss from 103.12 investment entities2010-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Assets. Invements in employer securities at end of year2010-12-31$0
Assets. Invements in employer securities at beginning of year2010-12-31$0
Assets. Value of employer real property at end of year2010-12-31$0
Assets. Value of employer real property at beginning of year2010-12-31$0
Contributions received in cash from employer2010-12-31$147,594
Employer contributions (assets) at end of year2010-12-31$0
Employer contributions (assets) at beginning of year2010-12-31$0
Income. Dividends from preferred stock2010-12-31$0
Income. Dividends from common stock2010-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$53,582
Asset. Corporate debt instrument preferred debt at end of year2010-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2010-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2010-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2010-12-31$0
Contract administrator fees2010-12-31$2,478
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2010-12-31$0
Liabilities. Value of benefit claims payable at end of year2010-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2010-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2010-12-31$0
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$0
Aggregate carrying amount (costs) on sale of assets2010-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2010-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2010-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31ROSEN SEYMOUR SHAPSS MARTIN & CO LL
Accountancy firm EIN2010-12-31135653927
2009 : GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 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 GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST

2014: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 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: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 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: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 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: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 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 benefit arrangement – InsuranceYes
2010: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 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 benefit arrangement – InsuranceYes
2009: GYM SOURCE USA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )
Policy contract number800293
Policy instance 1
Insurance contract or identification number800293
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $14,660
Total amount of fees paid to insurance companyUSD $5,195
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 $14,660
Amount paid for insurance broker fees110
Additional information about fees paid to insurance brokerOTHER ALLOWANCES
Insurance broker organization code?3
Insurance broker nameSOUTHEASTERN EMPLOYEE BENEFITS
FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number380002-01
Policy instance 2
Insurance contract or identification number380002-01
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?Yes
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 OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )
Policy contract number800293
Policy instance 1
Insurance contract or identification number800293
Number of Individuals Covered69
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $23,855
Total amount of fees paid to insurance companyUSD $6,369
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
Amount paid for insurance broker fees6369
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $23,855
Insurance broker nameMORGAN STANLEY INSURANCE
FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number380002-01
Policy instance 1
Insurance contract or identification number380002-01
Number of Individuals Covered67
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number380002-01
Policy instance 1
Insurance contract or identification number380002-01
Number of Individuals Covered63
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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

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