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IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 401k Plan overview

Plan NameIOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN
Plan identification number 001

IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

IOWA BEVERAGE SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name:IOWA BEVERAGE SYSTEMS, INC.
Employer identification number (EIN):421315877
NAIC Classification:424800

Additional information about IOWA BEVERAGE SYSTEMS, INC.

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 1988-01-22
Company Identification Number: 119793
Legal Registered Office Address: 666 WALNUT STREET
SUITE 2000
DES MOINES
United States of America (USA)
50309

More information about IOWA BEVERAGE SYSTEMS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01TREVOR GOSSELINK2023-10-10
0012021-01-01TREVOR GOSSELINK2022-10-07
0012020-01-01TREVOR GOSSELINK2021-10-14
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01TREVOR GOSSELINK TREVOR GOSSELINK2014-07-29
0012012-01-01TREVOR GOSSELINK
0012011-01-01TIM DEGROOTE

Plan Statistics for IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN

401k plan membership statisitcs for IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN

Measure Date Value
2022: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01329
Total number of active participants reported on line 7a of the Form 55002022-01-01307
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0141
Total of all active and inactive participants2022-01-01348
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01348
Number of participants with account balances2022-01-01292
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0168
2021: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01328
Total number of active participants reported on line 7a of the Form 55002021-01-01219
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-01110
Total of all active and inactive participants2021-01-01329
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01329
Number of participants with account balances2021-01-01302
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0167
2020: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01308
Total number of active participants reported on line 7a of the Form 55002020-01-01246
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0182
Total of all active and inactive participants2020-01-01328
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01328
Number of participants with account balances2020-01-01265
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0152
2013: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01120
Total number of active participants reported on line 7a of the Form 55002013-01-0184
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0112
Total of all active and inactive participants2013-01-0196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0196
Number of participants with account balances2013-01-0163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01117
Total number of active participants reported on line 7a of the Form 55002012-01-0173
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0147
Total of all active and inactive participants2012-01-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01120
Number of participants with account balances2012-01-0190
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-014
2011: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01125
Total number of active participants reported on line 7a of the Form 55002011-01-0179
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0138
Total of all active and inactive participants2011-01-01117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01117
Number of participants with account balances2011-01-0190
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012

Financial Data on IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN

Measure Date Value
2022 : IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-2,215,264
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,283,509
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,203,126
Value of total corrective distributions2022-12-31$3,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,114,662
Value of total assets at end of year2022-12-31$14,851,980
Value of total assets at beginning of year2022-12-31$18,350,753
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$76,457
Total interest from all sources2022-12-31$13,420
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$15,798
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$15,798
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$807,888
Participant contributions at end of year2022-12-31$25,439
Participant contributions at beginning of year2022-12-31$186
Assets. Other investments not covered elsewhere at end of year2022-12-31$126,914
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$199,592
Other income not declared elsewhere2022-12-31$-89,874
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-3,498,773
Value of net assets at end of year (total assets less liabilities)2022-12-31$14,851,980
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$18,350,753
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$1,691,650
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$2,216,932
Value of interest in pooled separate accounts at end of year2022-12-31$1,557,761
Value of interest in pooled separate accounts at beginning of year2022-12-31$1,708,157
Interest earned on other investments2022-12-31$13,420
Value of interest in common/collective trusts at end of year2022-12-31$10,532,561
Value of interest in common/collective trusts at beginning of year2022-12-31$13,471,616
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$909,356
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$753,786
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-708,101
Net investment gain/loss from pooled separate accounts2022-12-31$-295,644
Net investment gain or loss from common/collective trusts2022-12-31$-2,265,525
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$306,774
Employer contributions (assets) at end of year2022-12-31$8,299
Employer contributions (assets) at beginning of year2022-12-31$484
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,203,126
Contract administrator fees2022-12-31$76,457
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31RSM US LLP
Accountancy firm EIN2022-12-31420714325
2021 : IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$3,877,160
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$3,727,750
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$3,634,722
Value of total corrective distributions2021-12-31$3,323
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,357,557
Value of total assets at end of year2021-12-31$18,350,753
Value of total assets at beginning of year2021-12-31$18,201,343
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$89,705
Total interest from all sources2021-12-31$10,770
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$12,379
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$12,379
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$764,302
Participant contributions at end of year2021-12-31$186
Participant contributions at beginning of year2021-12-31$22,220
Assets. Other investments not covered elsewhere at end of year2021-12-31$199,592
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$333,945
Other income not declared elsewhere2021-12-31$-10,264
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$149,410
Value of net assets at end of year (total assets less liabilities)2021-12-31$18,350,753
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$18,201,343
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$2,216,932
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$2,094,055
Value of interest in pooled separate accounts at end of year2021-12-31$1,708,157
Value of interest in pooled separate accounts at beginning of year2021-12-31$2,981,482
Interest earned on other investments2021-12-31$10,770
Value of interest in common/collective trusts at end of year2021-12-31$13,471,616
Value of interest in common/collective trusts at beginning of year2021-12-31$12,671,917
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$753,786
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$421,133
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$295,278
Net investment gain/loss from pooled separate accounts2021-12-31$411,869
Net investment gain or loss from common/collective trusts2021-12-31$1,799,571
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$259,310
Employer contributions (assets) at end of year2021-12-31$484
Employer contributions (assets) at beginning of year2021-12-31$10,536
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$3,634,722
Contract administrator fees2021-12-31$89,705
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31RSM US LLP
Accountancy firm EIN2021-12-31420714325
2020 : IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$13,045,133
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$3,969,656
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$3,442,477
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$3,355,654
Value of total corrective distributions2020-12-31$11,360
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,383,607
Value of total assets at end of year2020-12-31$18,201,343
Value of total assets at beginning of year2020-12-31$4,629,031
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$75,463
Total interest from all sources2020-12-31$3,799
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$10,186
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$10,186
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$767,555
Participant contributions at end of year2020-12-31$22,220
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$286,237
Other income not declared elsewhere2020-12-31$610
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$527,179
Value of net assets at end of year (total assets less liabilities)2020-12-31$18,201,343
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$4,629,031
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$2,094,055
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$2,138,477
Value of interest in pooled separate accounts at end of year2020-12-31$2,981,482
Value of interest in pooled separate accounts at beginning of year2020-12-31$616,637
Interest earned on other investments2020-12-31$3,799
Value of interest in common/collective trusts at end of year2020-12-31$12,671,917
Value of interest in common/collective trusts at beginning of year2020-12-31$1,771,594
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$421,133
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$99,426
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$563,845
Net investment gain/loss from pooled separate accounts2020-12-31$395,507
Net investment gain or loss from common/collective trusts2020-12-31$1,612,102
Net gain/loss from 103.12 investment entities2020-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$329,815
Employer contributions (assets) at end of year2020-12-31$10,536
Employer contributions (assets) at beginning of year2020-12-31$2,897
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$3,355,654
Contract administrator fees2020-12-31$75,463
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31RSM US LLP
Accountancy firm EIN2020-12-31420714325
2013 : IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$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$778,590
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$594,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$593,408
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$244,183
Value of total assets at end of year2013-12-31$3,473,146
Value of total assets at beginning of year2013-12-31$3,289,251
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$1,287
Total interest from all sources2013-12-31$1,403
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$2,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$171,998
Participant contributions at end of year2013-12-31$72
Participant contributions at beginning of year2013-12-31$2,795
Total non interest bearing cash at end of year2013-12-31$2,216
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$183,895
Value of net assets at end of year (total assets less liabilities)2013-12-31$3,473,146
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$3,289,251
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$1,287
Value of interest in pooled separate accounts at end of year2013-12-31$3,184,892
Value of interest in pooled separate accounts at beginning of year2013-12-31$2,890,699
Interest earned on other investments2013-12-31$1,403
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$282,567
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$393,282
Net investment gain/loss from pooled separate accounts2013-12-31$533,004
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$72,185
Employer contributions (assets) at end of year2013-12-31$3,399
Employer contributions (assets) at beginning of year2013-12-31$2,475
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$593,408
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31ROTH AND COMPANY, P.C.
Accountancy firm EIN2013-12-31421361038
2012 : IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$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$614,310
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$106,680
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$106,680
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$288,898
Value of total assets at end of year2012-12-31$3,289,251
Value of total assets at beginning of year2012-12-31$2,781,621
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$0
Total interest from all sources2012-12-31$1,840
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$2,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$198,719
Participant contributions at end of year2012-12-31$2,795
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$19,037
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$507,630
Value of net assets at end of year (total assets less liabilities)2012-12-31$3,289,251
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$2,781,621
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in pooled separate accounts at end of year2012-12-31$2,890,699
Value of interest in pooled separate accounts at beginning of year2012-12-31$2,402,447
Interest earned on other investments2012-12-31$1,840
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$420
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$420
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$393,282
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$378,152
Net investment gain/loss from pooled separate accounts2012-12-31$323,572
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$71,142
Employer contributions (assets) at end of year2012-12-31$2,475
Employer contributions (assets) at beginning of year2012-12-31$602
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$106,680
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31ROTH AND COMPANY P.C.
Accountancy firm EIN2012-12-31421361038
2011 : IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$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$186,574
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$98,874
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$98,874
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$278,186
Value of total assets at end of year2011-12-31$2,781,621
Value of total assets at beginning of year2011-12-31$2,693,921
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$0
Total interest from all sources2011-12-31$1,862
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$300,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$207,089
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$87,700
Value of net assets at end of year (total assets less liabilities)2011-12-31$2,781,621
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$2,693,921
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in pooled separate accounts at end of year2011-12-31$2,402,447
Value of interest in pooled separate accounts at beginning of year2011-12-31$2,340,674
Interest earned on other investments2011-12-31$1,862
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$420
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$9,535
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$9,535
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$378,152
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$343,712
Net investment gain/loss from pooled separate accounts2011-12-31$-93,474
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$71,097
Employer contributions (assets) at end of year2011-12-31$602
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$98,874
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31ROTH & COMPANY P.C.
Accountancy firm EIN2011-12-31421361038
2010 : IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$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$554,000
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$250,006
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$250,006
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$275,297
Value of total assets at end of year2010-12-31$2,693,921
Value of total assets at beginning of year2010-12-31$2,389,927
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$0
Total interest from all sources2010-12-31$2,088
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$300,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$203,564
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$256
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$303,994
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,693,921
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,389,927
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in pooled separate accounts at end of year2010-12-31$2,340,674
Value of interest in pooled separate accounts at beginning of year2010-12-31$2,051,070
Interest earned on other investments2010-12-31$2,088
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$9,535
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$343,712
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$338,857
Net investment gain/loss from pooled separate accounts2010-12-31$276,615
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$71,477
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$250,006
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31ROTH & COMPANY P.C.
Accountancy firm EIN2010-12-31421361038

Form 5500 Responses for IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN

2022: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2013: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: IOWA BEVERAGE SYSTEMS, INC. EMPLOYEES' PROFIT SHARING AND 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered348
Insurance policy start date2022-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,186
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1186
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered347
Insurance policy start date2021-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,168
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1168
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered341
Insurance policy start date2020-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,023
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1023
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36136
Policy instance 1
Insurance contract or identification number36136
Number of Individuals Covered63
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,300
Total amount of fees paid to insurance companyUSD $1,628
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,182
Insurance broker organization code?3
Amount paid for insurance broker fees1613
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameVERISIGHT, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36136
Policy instance 1
Insurance contract or identification number36136
Number of Individuals Covered89
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $8,894
Total amount of fees paid to insurance companyUSD $1,413
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,771
Insurance broker organization code?3
Amount paid for insurance broker fees1394
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameVERISIGHT, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36136
Policy instance 1
Insurance contract or identification number36136
Number of Individuals Covered89
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,428
Total amount of fees paid to insurance companyUSD $1,396
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36136
Policy instance 1
Insurance contract or identification number36136
Number of Individuals Covered90
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,490
Total amount of fees paid to insurance companyUSD $1,205
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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