401k Plan data: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN plan

BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 401k Plan overview

Plan Name	BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN
Plan identification number	001

BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN Benefits

401k Plan Type

Defined 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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BIRCH GROVE LANDSCAPING & NURSERY has sponsored the creation of one or more 401k plans.

Company Name: BIRCH GROVE LANDSCAPING & NURSERY

Employer identification number (EIN): 161192906

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01
001 2014-01-01 JENI BURFORD 2015-09-28
001 2013-01-01 JENI BURFORD
001 2012-01-01 JENI BURFORD
001 2011-01-01 JENI BURFORD
001 2010-01-01 JASON BURFORD
001 2009-01-01 JASON BURFORD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2015-01-01
001	2014-01-01	JENI BURFORD	2015-09-28
001	2013-01-01	JENI BURFORD
001	2012-01-01	JENI BURFORD
001	2011-01-01	JENI BURFORD
001	2010-01-01	JASON BURFORD
001	2009-01-01	JASON BURFORD

Plan Statistics for BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN

401k plan membership statisitcs for BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN

Measure Date Value
2013: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 19
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 19
Number of participants with account balances 2013-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 16
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 20
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 23
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 23
Number of participants with account balances 2011-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 27
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 28
Number of participants with account balances 2010-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 2
2009: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 21
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 7
Total of all active and inactive participants 2009-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 28
Number of participants with account balances 2009-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2013: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	19
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	19
Number of participants with account balances	2013-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	16
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	4
Total of all active and inactive participants	2012-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	20
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	23
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	23
Number of participants with account balances	2011-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	27
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	28
Number of participants with account balances	2010-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	2
2009: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	21
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	7
Total of all active and inactive participants	2009-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	28
Number of participants with account balances	2009-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN

Measure	Date	Value
2013 : BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$135,276
Expenses. Total of all expenses incurred	2013-12-31	$123,278
Benefits paid (including direct rollovers)	2013-12-31	$123,278
Total plan assets at end of year	2013-12-31	$616,019
Total plan assets at beginning of year	2013-12-31	$604,021
Value of fidelity bond covering the plan	2013-12-31	$100,000
Assets. Value of tangible personal property	2013-12-31	$0
Total contributions received or receivable from participants	2013-12-31	$39,547
Assets. Value of loans (other than to participants)	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$95,729
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$11,998
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$616,019
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$604,021
Assets. Value of participant loans	2013-12-31	$37,601
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2013-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2013-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$0
Assets. Value of real-estate (other than employer real property)	2013-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2013-12-31	$0
Assets. Value of employer securities	2013-12-31	$0
Assets. Value of employer real property	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2013-12-31	0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$117,952
2012 : BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$191,034
Expenses. Total of all expenses incurred	2012-12-31	$192,697
Benefits paid (including direct rollovers)	2012-12-31	$192,697
Total plan assets at end of year	2012-12-31	$604,021
Total plan assets at beginning of year	2012-12-31	$605,684
Value of fidelity bond covering the plan	2012-12-31	$0
Assets. Value of tangible personal property	2012-12-31	$0
Total contributions received or receivable from participants	2012-12-31	$68,980
Assets. Value of loans (other than to participants)	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$117,628
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$-1,663
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$604,021
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$605,684
Assets. Value of participant loans	2012-12-31	$41,398
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2012-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2012-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$0
Assets. Value of real-estate (other than employer real property)	2012-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2012-12-31	$0
Assets. Value of employer securities	2012-12-31	$0
Assets. Value of employer real property	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$4,426
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2012-12-31	0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$192,697
2011 : BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$-36,567
Expenses. Total of all expenses incurred	2011-12-31	$44,718
Benefits paid (including direct rollovers)	2011-12-31	$44,718
Total plan assets at end of year	2011-12-31	$602,200
Total plan assets at beginning of year	2011-12-31	$683,485
Value of fidelity bond covering the plan	2011-12-31	$0
Assets. Value of tangible personal property	2011-12-31	$0
Total contributions received or receivable from participants	2011-12-31	$63,983
Assets. Value of loans (other than to participants)	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$5,325
Other income received	2011-12-31	$-105,875
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-81,285
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$602,200
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$683,485
Assets. Value of participant loans	2011-12-31	$67,776
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2011-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2011-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$0
Assets. Value of real-estate (other than employer real property)	2011-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2011-12-31	$0
Assets. Value of employer securities	2011-12-31	$0
Assets. Value of employer real property	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
2010 : BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$107,926
Expenses. Total of all expenses incurred	2010-12-31	$118,048
Benefits paid (including direct rollovers)	2010-12-31	$118,048
Total plan assets at end of year	2010-12-31	$686,847
Total plan assets at beginning of year	2010-12-31	$696,969
Value of fidelity bond covering the plan	2010-12-31	$200,000
Total contributions received or receivable from participants	2010-12-31	$23,703
Other income received	2010-12-31	$84,223
Net income (gross income less expenses)	2010-12-31	$-10,122
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$686,847
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$696,969
Assets. Value of participant loans	2010-12-31	$85,119
2009 : BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN

2013: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: BIRCH GROVE LANDSCAPING & NURSERY DEFERRED PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380280-01

Policy instance

Insurance contract or identification number	380280-01
Number of Individuals Covered	17
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,692
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,346
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Insurance broker name	CHRISTOPHER WILLIAMS NML

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380280-01

Policy instance

Insurance contract or identification number	380280-01
Number of Individuals Covered	26
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,180
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,590
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	CHRISTOPHER WILLIAMS

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380280-01

Policy instance

Insurance contract or identification number	380280-01
Number of Individuals Covered	24
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,742
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
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 number

80617

Policy instance

Insurance contract or identification number	80617
Number of Individuals Covered	19
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,793
Total amount of fees paid to insurance company	USD $759
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,793
Insurance broker organization code?	3
Amount paid for insurance broker fees	759
Additional information about fees paid to insurance broker	TPA FEES & CONPENSATION
Insurance broker name	PENSION SERVICES OF WNY, INC.

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Company Name:	BIRCH GROVE LANDSCAPING & NURSERY
Employer identification number (EIN):	161192906
NAIC Classification:	238900