401k Plan data: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN plan

RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 401k Plan overview

Plan Name	RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN
Plan identification number	001

RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

RITSEMA ASSOCIATES has sponsored the creation of one or more 401k plans.

Company Name: RITSEMA ASSOCIATES

Employer identification number (EIN): 381678929

NAIC Classification: 238300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 LAURA EBELS 2023-05-30
001 2021-01-01 LAURA EBELS 2022-07-06 LAURA EBELS 2022-07-06
001 2020-01-01 LAURA EBELS 2021-07-28 LAURA EBELS 2021-07-28
001 2019-01-01 LAURA EBELS 2020-09-21
001 2018-01-01 LAURA EBELS 2019-07-11
001 2017-01-01 LAURA EBELS 2018-09-20
001 2016-01-01 LAURA EBELS 2017-07-10
001 2015-01-01 LAURA EBELS
001 2014-01-01 LAURA EBELS
001 2013-01-01 LAURA EBELS
001 2012-01-01 LAURA EBELS
001 2011-01-01 SHARON ELDERKIN
001 2010-01-01 SHARON ELDERKIN SHARON ELDERKIN 2011-10-05
001 2009-01-01 SHARON ELDERKIN SHARON ELDERKIN 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	LAURA EBELS	2023-05-30
001	2021-01-01	LAURA EBELS	2022-07-06	LAURA EBELS	2022-07-06
001	2020-01-01	LAURA EBELS	2021-07-28	LAURA EBELS	2021-07-28
001	2019-01-01	LAURA EBELS	2020-09-21
001	2018-01-01	LAURA EBELS	2019-07-11
001	2017-01-01	LAURA EBELS	2018-09-20
001	2016-01-01	LAURA EBELS	2017-07-10
001	2015-01-01	LAURA EBELS
001	2014-01-01	LAURA EBELS
001	2013-01-01	LAURA EBELS
001	2012-01-01	LAURA EBELS
001	2011-01-01	SHARON ELDERKIN
001	2010-01-01	SHARON ELDERKIN		SHARON ELDERKIN	2011-10-05
001	2009-01-01	SHARON ELDERKIN		SHARON ELDERKIN	2010-10-15

Plan Statistics for RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN

401k plan membership statisitcs for RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN

Measure Date Value
2015: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 76
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 16
Total of all active and inactive participants 2015-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 92
Number of participants with account balances 2015-01-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 78
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 21
Total of all active and inactive participants 2014-01-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 99
Number of participants with account balances 2014-01-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 94
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 23
Total of all active and inactive participants 2013-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 117
Number of participants with account balances 2013-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 111
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 35
Total of all active and inactive participants 2012-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 146
Number of participants with account balances 2012-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 98
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 29
Total of all active and inactive participants 2011-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 127
Number of participants with account balances 2011-01-01 127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2010: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 166
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 121
Number of retired or separated participants receiving benefits 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 24
Total of all active and inactive participants 2010-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 146
Number of participants with account balances 2010-01-01 146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 10
2009: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 149
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 16
Total of all active and inactive participants 2009-01-01 166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 166
Number of participants with account balances 2009-01-01 166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 13

Measure	Date	Value
2015: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	76
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	16
Total of all active and inactive participants	2015-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	92
Number of participants with account balances	2015-01-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	78
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	21
Total of all active and inactive participants	2014-01-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	99
Number of participants with account balances	2014-01-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	94
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	23
Total of all active and inactive participants	2013-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	117
Number of participants with account balances	2013-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	111
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	35
Total of all active and inactive participants	2012-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	146
Number of participants with account balances	2012-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	98
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	29
Total of all active and inactive participants	2011-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	127
Number of participants with account balances	2011-01-01	127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2010: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	166
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	121
Number of retired or separated participants receiving benefits	2010-01-01	1
Number of other retired or separated participants entitled to future benefits	2010-01-01	24
Total of all active and inactive participants	2010-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	146
Number of participants with account balances	2010-01-01	146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	10
2009: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	149
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	16
Total of all active and inactive participants	2009-01-01	166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	166
Number of participants with account balances	2009-01-01	166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	13

Financial Data on RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN

Measure	Date	Value
2015 : RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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	$17,874
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$400,635
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$400,635
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$108,370
Value of total assets at end of year	2015-12-31	$5,195,401
Value of total assets at beginning of year	2015-12-31	$5,578,162
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$0
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	$500,000
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	$108,370
Participant contributions at end of year	2015-12-31	$2,072
Participant contributions at beginning of year	2015-12-31	$1,960
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	$-382,761
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$5,195,401
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$5,578,162
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	$5,190,100
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$5,573,518
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$3,229
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$2,684
Net investment gain/loss from pooled separate accounts	2015-12-31	$-90,496
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$400,635
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	BEENE GARTER LLP
Accountancy firm EIN	2015-12-31	381337372
2014 : RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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	$437,749
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$856,953
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$856,536
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$132,256
Value of total assets at end of year	2014-12-31	$5,578,162
Value of total assets at beginning of year	2014-12-31	$5,997,366
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$417
Total interest from all sources	2014-12-31	$0
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	$500,000
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	$132,256
Participant contributions at end of year	2014-12-31	$1,960
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$417
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-419,204
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$5,578,162
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$5,997,366
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	$5,573,518
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$5,995,598
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$2,684
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,768
Net investment gain/loss from pooled separate accounts	2014-12-31	$305,493
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$856,536
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	BEENE GARTER LLP
Accountancy firm EIN	2014-12-31	381337372
2013 : RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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	$1,182,501
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$921,851
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$921,851
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$146,312
Value of total assets at end of year	2013-12-31	$5,997,366
Value of total assets at beginning of year	2013-12-31	$5,736,716
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$0
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	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	Yes
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	$146,312
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$537
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$474,525
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$1,129
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	$260,650
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$5,997,366
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$5,736,716
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	$5,995,598
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$5,260,525
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,768
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Net investment gain/loss from pooled separate accounts	2013-12-31	$1,036,189
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$921,851
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	2013-12-31	Yes
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	BAS PARTNERS LLC
Accountancy firm EIN	2013-12-31	208779390
2012 : RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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	$904,741
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$738,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$738,226
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$178,849
Value of total assets at end of year	2012-12-31	$5,736,716
Value of total assets at beginning of year	2012-12-31	$5,570,201
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$0
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	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
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	$178,849
Participant contributions at end of year	2012-12-31	$537
Participant contributions at beginning of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$474,525
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$1,129
Total non interest bearing cash at end of year	2012-12-31	$1,129
Total non interest bearing cash at beginning of year	2012-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$166,515
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$5,736,716
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$5,570,201
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$5,260,525
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$5,213,561
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$356,640
Net investment gain/loss from pooled separate accounts	2012-12-31	$724,763
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	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$738,226
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	2012-12-31	Yes
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	GALVAN AUDIT SERVICES, LLC
Accountancy firm EIN	2012-12-31	462502375
2011 : RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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	$-30,616
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,115,891
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,103,996
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$219,614
Value of total assets at end of year	2011-12-31	$5,570,201
Value of total assets at beginning of year	2011-12-31	$6,716,708
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$11,895
Total interest from all sources	2011-12-31	$23,050
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
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$192,853
Participant contributions at beginning of year	2011-12-31	$10,529
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$163
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$26,761
Administrative expenses (other) incurred	2011-12-31	$11,895
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	$-1,146,507
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$5,570,201
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$6,716,708
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 registered invesment companies (eg mutual funds) at end of year	2011-12-31	$5,213,561
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$6,084,678
Value of interest in pooled separate accounts at end of year	2011-12-31	$356,640
Interest earned on other investments	2011-12-31	$23,050
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$621,338
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-421,088
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	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,103,996
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	2011-12-31	Yes
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	PLANTE & MORAN PLLC
Accountancy firm EIN	2011-12-31	381357951
2010 : RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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	$983,850
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,443,871
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,415,037
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$231,466
Value of total assets at end of year	2010-12-31	$6,716,708
Value of total assets at beginning of year	2010-12-31	$7,176,729
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$28,834
Total interest from all sources	2010-12-31	$20,915
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$61,191
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$61,191
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	$219,448
Participant contributions at end of year	2010-12-31	$10,529
Participant contributions at beginning of year	2010-12-31	$5,298
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$163
Administrative expenses (other) incurred	2010-12-31	$28,834
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	$-460,021
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$6,716,708
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$7,176,729
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 registered invesment companies (eg mutual funds) at end of year	2010-12-31	$6,084,678
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$6,365,600
Interest earned on other investments	2010-12-31	$20,915
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$621,338
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$805,555
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$670,278
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	$12,018
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$276
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,415,037
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	PLANTE & MORAN PLLC
Accountancy firm EIN	2010-12-31	381357951

Form 5500 Responses for RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN

2015: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 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: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – 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: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – 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
2010: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: RITSEMA ASSOCIATES PROFIT SHARING AND 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

101063

Policy instance

Insurance contract or identification number	101063
Number of Individuals Covered	86
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $13,520
Total amount of fees paid to insurance company	USD $2,751
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,520
Insurance broker organization code?	3
Amount paid for insurance broker fees	2751
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	WATKINS, ROSS & CO.

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

Policy contract number

101063

Policy instance

Insurance contract or identification number	101063
Number of Individuals Covered	92
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,934
Total amount of fees paid to insurance company	USD $3,465
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 $14,934
Insurance broker organization code?	3
Amount paid for insurance broker fees	3465
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	WATKINS, ROSS & CO.

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

Policy contract number

101063

Policy instance

Insurance contract or identification number	101063
Number of Individuals Covered	103
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,404
Total amount of fees paid to insurance company	USD $2,916
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 $14,404
Insurance broker organization code?	3
Amount paid for insurance broker fees	2916
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	WATKINS, ROSS & CO.

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

Policy contract number

101063

Policy instance

Insurance contract or identification number	101063
Number of Individuals Covered	130
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,576
Total amount of fees paid to insurance company	USD $3,663
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 $7,576
Insurance broker organization code?	3
Amount paid for insurance broker fees	3663
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	WATKINS, ROSS & CO.

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

Policy contract number

101063

Policy instance

Insurance contract or identification number	101063
Number of Individuals Covered	127
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $61,165
Total amount of fees paid to insurance company	USD $11,650
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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

002393

Policy instance

Insurance contract or identification number	002393
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

GA39441

Policy instance

Insurance contract or identification number	GA39441
Number of Individuals Covered	146
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	RITSEMA ASSOCIATES
Employer identification number (EIN):	381678929
NAIC Classification:	238300