401k Plan data: BROTHER JAMES COURT RETIREMENT PLAN plan

BROTHER JAMES COURT RETIREMENT PLAN 401k Plan overview

Plan Name	BROTHER JAMES COURT RETIREMENT PLAN
Plan identification number	001

BROTHER JAMES COURT RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BROTHER JAMES COURT has sponsored the creation of one or more 401k plans.

Company Name: BROTHER JAMES COURT

Employer identification number (EIN): 371007739

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROTHER JAMES COURT RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-07-01 STEPHEN BISSLER 2023-08-06
001 2021-07-01 STEPHEN BISSLER 2023-02-28
001 2019-07-01
001 2018-07-01 SONIA BARTELS 2020-01-02
001 2017-07-01
001 2016-07-01
001 2015-07-01
001 2014-07-01
001 2013-07-01 STEPHEN BISSLER
001 2012-07-01 STEPHEN BISSLER 2015-08-27
001 2011-07-01 RON WAMPLER 2013-04-09
001 2010-07-01 RON WAMPLER 2012-01-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-07-01	STEPHEN BISSLER	2023-08-06
001	2021-07-01	STEPHEN BISSLER	2023-02-28
001	2019-07-01
001	2018-07-01	SONIA BARTELS	2020-01-02
001	2017-07-01
001	2016-07-01
001	2015-07-01
001	2014-07-01
001	2013-07-01	STEPHEN BISSLER
001	2012-07-01	STEPHEN BISSLER	2015-08-27
001	2011-07-01	RON WAMPLER	2013-04-09
001	2010-07-01	RON WAMPLER	2012-01-12

Plan Statistics for BROTHER JAMES COURT RETIREMENT PLAN

401k plan membership statisitcs for BROTHER JAMES COURT RETIREMENT PLAN

Measure Date Value
2019: BROTHER JAMES COURT RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 90
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 39
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 4
Total of all active and inactive participants 2019-07-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-07-01 0
Total participants 2019-07-01 43
Number of participants with account balances 2019-07-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-07-01 7
2018: BROTHER JAMES COURT RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 115
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 65
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 25
Total of all active and inactive participants 2018-07-01 90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-07-01 0
Total participants 2018-07-01 90
Number of participants with account balances 2018-07-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-07-01 22
2017: BROTHER JAMES COURT RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 116
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 75
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 25
Total of all active and inactive participants 2017-07-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 0
Total participants 2017-07-01 100
Number of participants with account balances 2017-07-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 28
2016: BROTHER JAMES COURT RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 112
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 75
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 24
Total of all active and inactive participants 2016-07-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-07-01 0
Total participants 2016-07-01 99
Number of participants with account balances 2016-07-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-07-01 22
2015: BROTHER JAMES COURT RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 115
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 65
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 24
Total of all active and inactive participants 2015-07-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 89
Number of participants with account balances 2015-07-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 16
2014: BROTHER JAMES COURT RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 120
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 65
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 34
Total of all active and inactive participants 2014-07-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 99
Number of participants with account balances 2014-07-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 15
2013: BROTHER JAMES COURT RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 130
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 63
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 42
Total of all active and inactive participants 2013-07-01 105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 0
Total participants 2013-07-01 105
Number of participants with account balances 2013-07-01 105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 24

Measure	Date	Value
2019: BROTHER JAMES COURT RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	90
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	39
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	4
Total of all active and inactive participants	2019-07-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-07-01	0
Total participants	2019-07-01	43
Number of participants with account balances	2019-07-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-07-01	7
2018: BROTHER JAMES COURT RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	115
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	65
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	25
Total of all active and inactive participants	2018-07-01	90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-07-01	0
Total participants	2018-07-01	90
Number of participants with account balances	2018-07-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-07-01	22
2017: BROTHER JAMES COURT RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	116
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	75
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	25
Total of all active and inactive participants	2017-07-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	0
Total participants	2017-07-01	100
Number of participants with account balances	2017-07-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	28
2016: BROTHER JAMES COURT RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	112
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	75
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	24
Total of all active and inactive participants	2016-07-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-07-01	0
Total participants	2016-07-01	99
Number of participants with account balances	2016-07-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-07-01	22
2015: BROTHER JAMES COURT RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	115
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	65
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	24
Total of all active and inactive participants	2015-07-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	89
Number of participants with account balances	2015-07-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	16
2014: BROTHER JAMES COURT RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	120
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	65
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	34
Total of all active and inactive participants	2014-07-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	99
Number of participants with account balances	2014-07-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	15
2013: BROTHER JAMES COURT RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	130
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	63
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	42
Total of all active and inactive participants	2013-07-01	105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	0
Total participants	2013-07-01	105
Number of participants with account balances	2013-07-01	105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	24

Financial Data on BROTHER JAMES COURT RETIREMENT PLAN

Measure	Date	Value
2020 : BROTHER JAMES COURT RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total income from all sources (including contributions)	2020-06-30	$46,699
Total loss/gain on sale of assets	2020-06-30	$0
Total of all expenses incurred	2020-06-30	$96,808
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$91,236
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$37,822
Value of total assets at end of year	2020-06-30	$301,164
Value of total assets at beginning of year	2020-06-30	$351,273
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$5,572
Total interest from all sources	2020-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$0
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$37,000
If this is an individual account plan, was there a blackout period	2020-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$37,822
Other income not declared elsewhere	2020-06-30	$1,286
Administrative expenses (other) incurred	2020-06-30	$5,572
Total non interest bearing cash at end of year	2020-06-30	$0
Total non interest bearing cash at beginning of year	2020-06-30	$2,033
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$-50,109
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$301,164
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$351,273
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$296,338
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$329,740
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-06-30	$4,826
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-06-30	$0
Net investment gain/loss from pooled separate accounts	2020-06-30	$7,591
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Employer contributions (assets) at end of year	2020-06-30	$0
Employer contributions (assets) at beginning of year	2020-06-30	$19,500
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$91,236
Did the plan have assets held for investment	2020-06-30	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	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-06-30	Disclaimer
Accountancy firm name	2020-06-30	MARTIN HOOD LLC
Accountancy firm EIN	2020-06-30	371119790
2019 : BROTHER JAMES COURT RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total income from all sources (including contributions)	2019-06-30	$78,164
Total loss/gain on sale of assets	2019-06-30	$0
Total of all expenses incurred	2019-06-30	$94,325
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$81,282
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$62,983
Value of total assets at end of year	2019-06-30	$351,273
Value of total assets at beginning of year	2019-06-30	$367,434
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$13,043
Total interest from all sources	2019-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-06-30	$0
Administrative expenses professional fees incurred	2019-06-30	$13,043
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$37,000
If this is an individual account plan, was there a blackout period	2019-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$43,483
Total non interest bearing cash at end of year	2019-06-30	$2,033
Total non interest bearing cash at beginning of year	2019-06-30	$5,035
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$-16,161
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$351,273
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$367,434
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-06-30	$329,740
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-06-30	$342,899
Net investment gain/loss from pooled separate accounts	2019-06-30	$15,181
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	No
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$19,500
Employer contributions (assets) at end of year	2019-06-30	$19,500
Employer contributions (assets) at beginning of year	2019-06-30	$19,500
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-06-30	$81,282
Did the plan have assets held for investment	2019-06-30	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	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2019-06-30	Disclaimer
Accountancy firm name	2019-06-30	MARTIN HOOD LLC
Accountancy firm EIN	2019-06-30	371119790
2018 : BROTHER JAMES COURT RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total income from all sources (including contributions)	2018-06-30	$81,753
Total loss/gain on sale of assets	2018-06-30	$0
Total of all expenses incurred	2018-06-30	$61,924
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$48,536
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$61,063
Value of total assets at end of year	2018-06-30	$367,434
Value of total assets at beginning of year	2018-06-30	$347,605
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$13,388
Total interest from all sources	2018-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-06-30	$0
Administrative expenses professional fees incurred	2018-06-30	$13,388
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$35,000
If this is an individual account plan, was there a blackout period	2018-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$41,563
Total non interest bearing cash at end of year	2018-06-30	$5,035
Total non interest bearing cash at beginning of year	2018-06-30	$9,469
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Value of net income/loss	2018-06-30	$19,829
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$367,434
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$347,605
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-06-30	$342,899
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-06-30	$318,636
Net investment gain/loss from pooled separate accounts	2018-06-30	$20,690
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	No
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$19,500
Employer contributions (assets) at end of year	2018-06-30	$19,500
Employer contributions (assets) at beginning of year	2018-06-30	$19,500
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-06-30	$48,536
Did the plan have assets held for investment	2018-06-30	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	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2018-06-30	Disclaimer
Accountancy firm name	2018-06-30	MARTIN HOOD LLC
Accountancy firm EIN	2018-06-30	371119790
2017 : BROTHER JAMES COURT RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total income from all sources (including contributions)	2017-06-30	$83,681
Total loss/gain on sale of assets	2017-06-30	$0
Total of all expenses incurred	2017-06-30	$165,473
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$152,348
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$43,021
Value of total assets at end of year	2017-06-30	$347,605
Value of total assets at beginning of year	2017-06-30	$429,397
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$13,125
Total interest from all sources	2017-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-06-30	$0
Administrative expenses professional fees incurred	2017-06-30	$5,132
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$250,000
If this is an individual account plan, was there a blackout period	2017-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Contributions received from participants	2017-06-30	$22,739
Income. Received or receivable in cash from other sources (including rollovers)	2017-06-30	$782
Total non interest bearing cash at end of year	2017-06-30	$9,469
Total non interest bearing cash at beginning of year	2017-06-30	$5,782
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$-81,792
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$347,605
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$429,397
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-06-30	$318,636
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-06-30	$404,115
Net investment gain/loss from pooled separate accounts	2017-06-30	$40,660
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	No
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Contributions received in cash from employer	2017-06-30	$19,500
Employer contributions (assets) at end of year	2017-06-30	$19,500
Employer contributions (assets) at beginning of year	2017-06-30	$19,500
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$152,348
Contract administrator fees	2017-06-30	$7,993
Did the plan have assets held for investment	2017-06-30	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	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2017-06-30	Disclaimer
Accountancy firm name	2017-06-30	MARTIN HOOD FRIESE & ASSOCIATES,LLC
Accountancy firm EIN	2017-06-30	371119790
2016 : BROTHER JAMES COURT RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total income from all sources (including contributions)	2016-06-30	$39,570
Total loss/gain on sale of assets	2016-06-30	$0
Total of all expenses incurred	2016-06-30	$50,537
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$41,378
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$41,066
Value of total assets at end of year	2016-06-30	$429,397
Value of total assets at beginning of year	2016-06-30	$440,364
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$9,159
Total interest from all sources	2016-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-06-30	$0
Administrative expenses professional fees incurred	2016-06-30	$3,806
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$250,000
If this is an individual account plan, was there a blackout period	2016-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Contributions received from participants	2016-06-30	$21,403
Income. Received or receivable in cash from other sources (including rollovers)	2016-06-30	$163
Total non interest bearing cash at end of year	2016-06-30	$5,782
Total non interest bearing cash at beginning of year	2016-06-30	$12,935
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$-10,967
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$429,397
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$440,364
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-06-30	$404,115
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-06-30	$349,429
Net investment gain/loss from pooled separate accounts	2016-06-30	$-1,496
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Contributions received in cash from employer	2016-06-30	$19,500
Employer contributions (assets) at end of year	2016-06-30	$19,500
Employer contributions (assets) at beginning of year	2016-06-30	$78,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-06-30	$41,378
Contract administrator fees	2016-06-30	$5,353
Did the plan have assets held for investment	2016-06-30	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	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-06-30	Disclaimer
Accountancy firm name	2016-06-30	MARTIN HOOD FRIESE & ASSOCIATES,LLC
Accountancy firm EIN	2016-06-30	371119790
2015 : BROTHER JAMES COURT RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$319
Total income from all sources (including contributions)	2015-06-30	$104,123
Total loss/gain on sale of assets	2015-06-30	$0
Total of all expenses incurred	2015-06-30	$254,190
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$249,488
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$100,627
Value of total assets at end of year	2015-06-30	$440,364
Value of total assets at beginning of year	2015-06-30	$590,750
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$4,702
Total interest from all sources	2015-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-06-30	$0
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$250,000
If this is an individual account plan, was there a blackout period	2015-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Contributions received from participants	2015-06-30	$16,990
Participant contributions at end of year	2015-06-30	$0
Participant contributions at beginning of year	2015-06-30	$919
Income. Received or receivable in cash from other sources (including rollovers)	2015-06-30	$5,637
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-06-30	$126
Other income not declared elsewhere	2015-06-30	$214
Total non interest bearing cash at end of year	2015-06-30	$12,935
Total non interest bearing cash at beginning of year	2015-06-30	$30,590
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Value of net income/loss	2015-06-30	$-150,067
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$440,364
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$590,431
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-06-30	$349,429
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-06-30	$508,727
Net investment gain/loss from pooled separate accounts	2015-06-30	$3,282
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	No
Was there a failure to transmit to the plan any participant contributions	2015-06-30	Yes
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Contributions received in cash from employer	2015-06-30	$78,000
Employer contributions (assets) at end of year	2015-06-30	$78,000
Employer contributions (assets) at beginning of year	2015-06-30	$50,514
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-06-30	$249,362
Contract administrator fees	2015-06-30	$4,702
Liabilities. Value of benefit claims payable at end of year	2015-06-30	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-06-30	$319
Did the plan have assets held for investment	2015-06-30	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	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2015-06-30	Disclaimer
Accountancy firm name	2015-06-30	MARTIN HOOD FRIESE & ASSOCIATES,LLC
Accountancy firm EIN	2015-06-30	371119790
2014 : BROTHER JAMES COURT RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$319
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total income from all sources (including contributions)	2014-06-30	$155,489
Total loss/gain on sale of assets	2014-06-30	$0
Total of all expenses incurred	2014-06-30	$166,906
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$160,775
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$78,025
Value of total assets at end of year	2014-06-30	$590,750
Value of total assets at beginning of year	2014-06-30	$601,848
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$6,131
Total interest from all sources	2014-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$250,000
If this is an individual account plan, was there a blackout period	2014-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$27,511
Participant contributions at end of year	2014-06-30	$919
Participant contributions at beginning of year	2014-06-30	$2,440
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-06-30	$0
Total non interest bearing cash at end of year	2014-06-30	$30,590
Total non interest bearing cash at beginning of year	2014-06-30	$22,952
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$-11,417
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$590,431
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$601,848
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-06-30	$509,646
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-06-30	$494,311
Net investment gain/loss from pooled separate accounts	2014-06-30	$77,464
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$50,514
Employer contributions (assets) at end of year	2014-06-30	$50,514
Employer contributions (assets) at beginning of year	2014-06-30	$84,585
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$160,775
Contract administrator fees	2014-06-30	$6,131
Liabilities. Value of benefit claims payable at end of year	2014-06-30	$319
Liabilities. Value of benefit claims payable at beginning of year	2014-06-30	$0
Did the plan have assets held for investment	2014-06-30	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	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-06-30	Disclaimer
Accountancy firm name	2014-06-30	MARTIN HOOD FRIESE & ASSOCIATES,LLC
Accountancy firm EIN	2014-06-30	371119790

Form 5500 Responses for BROTHER JAMES COURT RETIREMENT PLAN

2019: BROTHER JAMES COURT RETIREMENT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes
2018: BROTHER JAMES COURT RETIREMENT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	No
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – Trust	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement - Trust	Yes
2017: BROTHER JAMES COURT RETIREMENT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – Trust	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement - Trust	Yes
2016: BROTHER JAMES COURT RETIREMENT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – Trust	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement - Trust	Yes
2015: BROTHER JAMES COURT RETIREMENT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2014: BROTHER JAMES COURT RETIREMENT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2013: BROTHER JAMES COURT RETIREMENT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	Yes
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91693054

Policy instance

Insurance contract or identification number	91693054
Number of Individuals Covered	38
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $395
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
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
Other information about contract	GIC
Commission paid to Insurance Broker	USD $395
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

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

Policy contract number

38683

Policy instance

Insurance contract or identification number	38683
Number of Individuals Covered	78
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $824
Total amount of fees paid to insurance company	USD $68
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $824
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

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

Policy contract number

38683

Policy instance

Insurance contract or identification number	38683
Number of Individuals Covered	107
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $841
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $841
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	LPL FINANCIAL CORPORATION

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

Policy contract number

38683

Policy instance

Insurance contract or identification number	38683
Number of Individuals Covered	95
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $972
Total amount of fees paid to insurance company	USD $75
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 $972
Insurance broker organization code?	3
Amount paid for insurance broker fees	75
Additional information about fees paid to insurance broker	TPA FEES PAID
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

38683

Policy instance

Insurance contract or identification number	38683
Number of Individuals Covered	68
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $963
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?	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 $889
Insurance broker organization code?	3
Insurance broker name	LPL FINANCIAL CORPORATION

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

Policy contract number

38683

Policy instance

Insurance contract or identification number	38683
Number of Individuals Covered	74
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $1,231
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?	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 $1,231
Insurance broker organization code?	3
Insurance broker name	T.J. NICOUD & COMPANY

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Company Name:	BROTHER JAMES COURT
Employer identification number (EIN):	371007739
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities