401k Plan data: RSA MEDICAL LLC 401(K) PLAN & TRUST plan

RSA MEDICAL LLC 401(K) PLAN & TRUST 401k Plan overview

Plan Name	RSA MEDICAL LLC 401(K) PLAN & TRUST
Plan identification number	001

RSA MEDICAL LLC 401(K) PLAN & TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

RSA MEDICAL LLC has sponsored the creation of one or more 401k plans.

Company Name: RSA MEDICAL LLC

Employer identification number (EIN): 273235840

NAIC Classification: 524290

Additional information about RSA MEDICAL LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4859729

More information about RSA MEDICAL LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RSA MEDICAL LLC 401(K) PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01
001 2015-01-01
001 2014-01-01 ROCCO SALVIOLA
001 2013-01-01 ROCCO SALVIOLA
001 2012-01-01 ROCCO SALVIOLA
001 2011-01-01 ROCCO SALVIOLA

Plan Statistics for RSA MEDICAL LLC 401(K) PLAN & TRUST

401k plan membership statisitcs for RSA MEDICAL LLC 401(K) PLAN & TRUST

Measure Date Value
2016: RSA MEDICAL LLC 401(K) PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 379
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 5
2015: RSA MEDICAL LLC 401(K) PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 404
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 320
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 59
Total of all active and inactive participants 2015-01-01 379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 379
Number of participants with account balances 2015-01-01 218
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 34
2014: RSA MEDICAL LLC 401(K) PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 371
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 374
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 30
Total of all active and inactive participants 2014-01-01 404
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 404
Number of participants with account balances 2014-01-01 164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 14
2013: RSA MEDICAL LLC 401(K) PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 337
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 256
Number of retired or separated participants receiving benefits 2013-01-01 3
Number of other retired or separated participants entitled to future benefits 2013-01-01 38
Total of all active and inactive participants 2013-01-01 297
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 297
Number of participants with account balances 2013-01-01 152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 18
2012: RSA MEDICAL LLC 401(K) PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 353
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 248
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 36
Total of all active and inactive participants 2012-01-01 286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 286
Number of participants with account balances 2012-01-01 135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 18
2011: RSA MEDICAL LLC 401(K) PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 320
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 256
Number of retired or separated participants receiving benefits 2011-01-01 5
Number of other retired or separated participants entitled to future benefits 2011-01-01 40
Total of all active and inactive participants 2011-01-01 301
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 301
Number of participants with account balances 2011-01-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 34

Measure	Date	Value
2016: RSA MEDICAL LLC 401(K) PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	379
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	5
2015: RSA MEDICAL LLC 401(K) PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	404
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	320
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	59
Total of all active and inactive participants	2015-01-01	379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	379
Number of participants with account balances	2015-01-01	218
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	34
2014: RSA MEDICAL LLC 401(K) PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	371
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	374
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	30
Total of all active and inactive participants	2014-01-01	404
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	404
Number of participants with account balances	2014-01-01	164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	14
2013: RSA MEDICAL LLC 401(K) PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	337
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	256
Number of retired or separated participants receiving benefits	2013-01-01	3
Number of other retired or separated participants entitled to future benefits	2013-01-01	38
Total of all active and inactive participants	2013-01-01	297
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	297
Number of participants with account balances	2013-01-01	152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	18
2012: RSA MEDICAL LLC 401(K) PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	353
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	248
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	36
Total of all active and inactive participants	2012-01-01	286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	286
Number of participants with account balances	2012-01-01	135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	18
2011: RSA MEDICAL LLC 401(K) PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	320
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	256
Number of retired or separated participants receiving benefits	2011-01-01	5
Number of other retired or separated participants entitled to future benefits	2011-01-01	40
Total of all active and inactive participants	2011-01-01	301
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	301
Number of participants with account balances	2011-01-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	34

Financial Data on RSA MEDICAL LLC 401(K) PLAN & TRUST

Measure	Date	Value
2016 : RSA MEDICAL LLC 401(K) PLAN & TRUST 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-03-01	$0
Total transfer of assets from this plan	2016-03-01	$2,055,851
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-03-01	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-03-01	$0
Total income from all sources (including contributions)	2016-03-01	$-119,899
Total loss/gain on sale of assets	2016-03-01	$0
Total of all expenses incurred	2016-03-01	$49,604
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-03-01	$43,363
Value of total corrective distributions	2016-03-01	$2,438
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-03-01	$253
Value of total assets at end of year	2016-03-01	$0
Value of total assets at beginning of year	2016-03-01	$2,225,354
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-03-01	$3,803
Total interest from all sources	2016-03-01	$224
Total dividends received (eg from common stock, registered investment company shares)	2016-03-01	$0
Administrative expenses professional fees incurred	2016-03-01	$3,803
Was this plan covered by a fidelity bond	2016-03-01	Yes
Value of fidelity bond cover	2016-03-01	$1,000,000
If this is an individual account plan, was there a blackout period	2016-03-01	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-03-01	$0
Were there any nonexempt tranactions with any party-in-interest	2016-03-01	No
Participant contributions at end of year	2016-03-01	$0
Participant contributions at beginning of year	2016-03-01	$29,299
Participant contributions at end of year	2016-03-01	$0
Participant contributions at beginning of year	2016-03-01	$356
Income. Received or receivable in cash from other sources (including rollovers)	2016-03-01	$253
Total non interest bearing cash at end of year	2016-03-01	$0
Total non interest bearing cash at beginning of year	2016-03-01	$2,922
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-03-01	No
Value of net income/loss	2016-03-01	$-169,503
Value of net assets at end of year (total assets less liabilities)	2016-03-01	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-03-01	$2,225,354
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-03-01	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-03-01	No
Were any leases to which the plan was party in default or uncollectible	2016-03-01	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-03-01	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-03-01	$2,186,774
Interest on participant loans	2016-03-01	$212
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-03-01	$12
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-03-01	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-03-01	$5,939
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-03-01	No
Was there a failure to transmit to the plan any participant contributions	2016-03-01	No
Has the plan failed to provide any benefit when due under the plan	2016-03-01	No
Employer contributions (assets) at end of year	2016-03-01	$0
Employer contributions (assets) at beginning of year	2016-03-01	$64
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-03-01	$43,363
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-03-01	Yes
Did the plan have assets held for investment	2016-03-01	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-03-01	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-03-01	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-03-01	Yes
Opinion of an independent qualified public accountant for this plan	2016-03-01	Disclaimer
Accountancy firm name	2016-03-01	DIGIOVINE HNILO JORDAN JOHNSON LT
Accountancy firm EIN	2016-03-01	363029663
2015 : RSA MEDICAL LLC 401(K) PLAN & TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$487,852
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$226,867
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$198,322
Value of total corrective distributions	2015-12-31	$6,384
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$529,313
Value of total assets at end of year	2015-12-31	$2,225,354
Value of total assets at beginning of year	2015-12-31	$1,964,369
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$22,161
Total interest from all sources	2015-12-31	$1,433
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$471,326
Participant contributions at end of year	2015-12-31	$29,299
Participant contributions at beginning of year	2015-12-31	$35,119
Participant contributions at end of year	2015-12-31	$356
Participant contributions at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$2,922
Total non interest bearing cash at beginning of year	2015-12-31	$11,602
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$260,985
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,225,354
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,964,369
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,186,774
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,913,537
Interest on participant loans	2015-12-31	$1,375
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$58
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$5,939
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$4,111
Net investment gain/loss from pooled separate accounts	2015-12-31	$-42,894
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$57,987
Employer contributions (assets) at end of year	2015-12-31	$64
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$198,322
Contract administrator fees	2015-12-31	$22,161
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	DIGIOVINE HNILO JORDAN JOHNSON LT
Accountancy firm EIN	2015-12-31	363029663
2014 : RSA MEDICAL LLC 401(K) PLAN & TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$530,535
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$406,641
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$383,436
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$441,076
Value of total assets at end of year	2014-12-31	$1,964,369
Value of total assets at beginning of year	2014-12-31	$1,840,475
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$23,205
Total interest from all sources	2014-12-31	$1,388
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 year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$362,877
Participant contributions at end of year	2014-12-31	$35,119
Participant contributions at beginning of year	2014-12-31	$43,557
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$24,187
Total non interest bearing cash at end of year	2014-12-31	$11,602
Total non interest bearing cash at beginning of year	2014-12-31	$3,709
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$123,894
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,964,369
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,840,475
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,913,537
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,789,264
Interest on participant loans	2014-12-31	$1,338
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$50
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$4,111
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$3,945
Net investment gain/loss from pooled separate accounts	2014-12-31	$88,071
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at end of year	2014-12-31	$0
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$54,012
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$383,436
Contract administrator fees	2014-12-31	$23,205
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	DIGIOVINE HNILO JORDAN JOHNSON LT
Accountancy firm EIN	2014-12-31	363029663
2013 : RSA MEDICAL LLC 401(K) PLAN & TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$754,946
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$201,320
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$180,256
Expenses. Certain deemed distributions of participant loans	2013-12-31	$1,536
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$519,514
Value of total assets at end of year	2013-12-31	$1,840,475
Value of total assets at beginning of year	2013-12-31	$1,286,849
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$19,528
Total interest from all sources	2013-12-31	$1,142
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 year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$295,255
Participant contributions at end of year	2013-12-31	$43,557
Participant contributions at beginning of year	2013-12-31	$28,379
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$181,871
Total non interest bearing cash at end of year	2013-12-31	$3,709
Total non interest bearing cash at beginning of year	2013-12-31	$6,446
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$553,626
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,840,475
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,286,849
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,789,264
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,249,096
Interest on participant loans	2013-12-31	$1,093
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$49
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$3,945
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,928
Net investment gain/loss from pooled separate accounts	2013-12-31	$234,290
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$0
Assets. Invements in employer securities at beginning of year	2013-12-31	$0
Contributions received in cash from employer	2013-12-31	$42,388
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$180,256
Contract administrator fees	2013-12-31	$19,528
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	DIGIOVINE HNILO JORDAN JOHNSON LT
Accountancy firm EIN	2013-12-31	363029663
2012 : RSA MEDICAL LLC 401(K) PLAN & TRUST 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$411,898
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$118,786
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$84,752
Expenses. Certain deemed distributions of participant loans	2012-12-31	$2,727
Value of total corrective distributions	2012-12-31	$12,946
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$272,017
Value of total assets at end of year	2012-12-31	$1,286,849
Value of total assets at beginning of year	2012-12-31	$993,737
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$18,361
Total interest from all sources	2012-12-31	$1,018
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 year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$216,482
Participant contributions at end of year	2012-12-31	$28,379
Participant contributions at beginning of year	2012-12-31	$13,999
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$15,521
Total non interest bearing cash at end of year	2012-12-31	$6,446
Total non interest bearing cash at beginning of year	2012-12-31	$412
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$293,112
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,286,849
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$993,737
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$3,750
Value of interest in pooled separate accounts at end of year	2012-12-31	$1,249,096
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$975,333
Interest on participant loans	2012-12-31	$975
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$43
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,928
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$3,993
Net investment gain/loss from pooled separate accounts	2012-12-31	$138,863
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$40,014
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$84,752
Contract administrator fees	2012-12-31	$14,611
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	DIGIOVINE HNILO JORDAN JOHNSON LT
Accountancy firm EIN	2012-12-31	363029663
2011 : RSA MEDICAL LLC 401(K) PLAN & TRUST 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$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
Total income from all sources (including contributions)	2011-12-31	$317,906
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$56,661
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$40,800
Value of total corrective distributions	2011-12-31	$1,321
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$352,860
Value of total assets at end of year	2011-12-31	$993,737
Value of total assets at beginning of year	2011-12-31	$732,492
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$14,540
Total interest from all sources	2011-12-31	$547
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 year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$1,650
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$230,699
Participant contributions at end of year	2011-12-31	$13,999
Participant contributions at beginning of year	2011-12-31	$7,800
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$80,269
Total non interest bearing cash at end of year	2011-12-31	$412
Total non interest bearing cash at beginning of year	2011-12-31	$961
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$261,245
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$993,737
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$732,492
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$975,333
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$720,527
Interest on participant loans	2011-12-31	$448
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$99
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$3,993
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$3,204
Net investment gain/loss from pooled separate accounts	2011-12-31	$-35,501
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$41,892
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$40,800
Contract administrator fees	2011-12-31	$12,890
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	DIGIOVINE HNILO JORDAN JOHNSON LT
Accountancy firm EIN	2011-12-31	363029663
2010 : RSA MEDICAL LLC 401(K) PLAN & TRUST 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$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
Total income from all sources (including contributions)	2010-12-31	$329,873
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$37,961
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$8,664
Value of total corrective distributions	2010-12-31	$19,348
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$250,387
Value of total assets at end of year	2010-12-31	$732,492
Value of total assets at beginning of year	2010-12-31	$440,580
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$9,949
Total interest from all sources	2010-12-31	$274
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 year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$1,021
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$197,559
Participant contributions at end of year	2010-12-31	$7,800
Participant contributions at beginning of year	2010-12-31	$0
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$15,311
Total non interest bearing cash at end of year	2010-12-31	$961
Total non interest bearing cash at beginning of year	2010-12-31	$1,362
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$291,912
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$732,492
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$440,580
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$720,527
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$436,587
Interest on participant loans	2010-12-31	$184
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$90
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$3,204
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,631
Net investment gain/loss from pooled separate accounts	2010-12-31	$79,212
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$37,517
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$8,664
Contract administrator fees	2010-12-31	$8,928
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	DIGIOVINE HNILO JORDAN JOHNSON LT
Accountancy firm EIN	2010-12-31	363029663

Form 5500 Responses for RSA MEDICAL LLC 401(K) PLAN & TRUST

2016: RSA MEDICAL LLC 401(K) PLAN & TRUST 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: RSA MEDICAL LLC 401(K) PLAN & TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: RSA MEDICAL LLC 401(K) PLAN & TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: RSA MEDICAL LLC 401(K) PLAN & TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: RSA MEDICAL LLC 401(K) PLAN & TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: RSA MEDICAL LLC 401(K) PLAN & TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

35818

Policy instance

Insurance contract or identification number	35818
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2016-03-01
Total amount of commissions paid to insurance broker	USD $2,480
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?	Yes
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 $1,730
Insurance broker organization code?	7
Insurance broker name	SIKICH LLP

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

Policy contract number

35818

Policy instance

Insurance contract or identification number	35818
Number of Individuals Covered	218
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,149
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?	Yes
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 $10,399
Insurance broker organization code?	7
Insurance broker name	SIKICH LLP

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

Policy contract number

35818

Policy instance

Insurance contract or identification number	35818
Number of Individuals Covered	178
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,116
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?	Yes
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 $7,833
Insurance broker organization code?	7
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

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

Policy contract number

35818

Policy instance

Insurance contract or identification number	35818
Number of Individuals Covered	291
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,878
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?	Yes
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 $7,253
Insurance broker organization code?	3
Insurance broker name	SIKICH LLP

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

Policy contract number

35818

Policy instance

Insurance contract or identification number	35818
Number of Individuals Covered	286
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,385
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?	Yes
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 $5,635
Insurance broker organization code?	3
Insurance broker name	SIKICH LLP

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

Policy contract number

35818

Policy instance

Insurance contract or identification number	35818
Number of Individuals Covered	191
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,150
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?	Yes
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

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

Policy contract number

35818

Policy instance

Insurance contract or identification number	35818
Number of Individuals Covered	134
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,669
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?	Yes
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

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Company Name:	RSA MEDICAL LLC
Employer identification number (EIN):	273235840
NAIC Classification:	524290

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4859729