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FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameFOUTS BROS. INC. 401(K) PROFIT SHARING PLAN
Plan identification number 001

FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN Benefits

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

401k Sponsoring company profile

FOUTS BROS INC has sponsored the creation of one or more 401k plans.

Company Name:FOUTS BROS INC
Employer identification number (EIN):581796263
NAIC Classification:811110
NAIC Description: Automotive Mechanical and Electrical Repair and Maintenance

Additional information about FOUTS BROS INC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 750635

More information about FOUTS BROS INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01KEVIN JOHNSON
0012017-01-01SCOTT EDENS
0012016-02-01KEVIN JOHNSON KEVIN JOHNSON2017-07-17
0012016-01-01SCOTT EDENS
0012015-01-01SCOTT EDENS
0012014-01-01SCOTT EDENS2015-10-08
0012013-01-01SCOTT EDENS2014-09-25
0012012-01-01TIM A. FOUTS2013-10-07
0012011-01-01TIM A. FOUTS2012-06-14
0012010-01-01TIM A. FOUTS2011-07-14

Plan Statistics for FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01179
Total number of active participants reported on line 7a of the Form 55002022-01-01175
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0125
Total of all active and inactive participants2022-01-01200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01200
Number of participants with account balances2022-01-0164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01191
Total number of active participants reported on line 7a of the Form 55002021-01-01161
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0120
Total of all active and inactive participants2021-01-01181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01181
Number of participants with account balances2021-01-0158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01146
Total number of active participants reported on line 7a of the Form 55002020-01-01131
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-0122
Total of all active and inactive participants2020-01-01154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01154
Number of participants with account balances2020-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01163
Total number of active participants reported on line 7a of the Form 55002019-01-01137
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0115
Total of all active and inactive participants2019-01-01152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01152
Number of participants with account balances2019-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01141
Total number of active participants reported on line 7a of the Form 55002018-01-01154
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0112
Total of all active and inactive participants2018-01-01166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01166
Number of participants with account balances2018-01-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01110
Total number of active participants reported on line 7a of the Form 55002017-01-01262
Number of retired or separated participants receiving benefits2017-01-011
Total of all active and inactive participants2017-01-01263
Total participants2017-01-01263
Number of other retired or separated participants entitled to future benefits2017-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Number of participants with account balances2017-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01100
Total number of active participants reported on line 7a of the Form 55002016-02-01170
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-02-010
Total participants2016-02-01170
Number of participants with account balances2016-02-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-02-010
Total participants, beginning-of-year2016-01-01161
Total number of active participants reported on line 7a of the Form 55002016-01-01142
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0110
Total of all active and inactive participants2016-01-01152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01152
Number of participants with account balances2016-01-0150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01150
Total number of active participants reported on line 7a of the Form 55002015-01-01146
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-0111
Total of all active and inactive participants2015-01-01158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01158
Number of participants with account balances2015-01-0152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011

Financial Data on FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : FOUTS BROS. INC. 401(K) PROFIT SHARING 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$0
Total income from all sources (including contributions)2022-12-31$-294,552
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$129,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$119,931
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$320,007
Value of total assets at end of year2022-12-31$3,032,382
Value of total assets at beginning of year2022-12-31$3,456,320
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$9,455
Total interest from all sources2022-12-31$3,309
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$350,000
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$203,263
Participant contributions at end of year2022-12-31$75,013
Participant contributions at beginning of year2022-12-31$32,362
Participant contributions at end of year2022-12-31$4,328
Participant contributions at beginning of year2022-12-31$2,591
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-423,938
Value of net assets at end of year (total assets less liabilities)2022-12-31$3,032,382
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,456,320
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 pooled separate accounts at end of year2022-12-31$2,950,219
Value of interest in pooled separate accounts at beginning of year2022-12-31$3,419,721
Interest on participant loans2022-12-31$3,309
Net investment gain/loss from pooled separate accounts2022-12-31$-617,868
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$116,744
Employer contributions (assets) at end of year2022-12-31$2,822
Employer contributions (assets) at beginning of year2022-12-31$1,646
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$119,931
Contract administrator fees2022-12-31$9,455
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 name2022-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2022-12-31581844576
2021 : FOUTS BROS. INC. 401(K) PROFIT SHARING 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$621,804
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$111,853
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$109,218
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$246,122
Value of total assets at end of year2021-12-31$3,456,320
Value of total assets at beginning of year2021-12-31$2,946,369
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$2,635
Total interest from all sources2021-12-31$2,854
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$300,000
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$138,615
Participant contributions at end of year2021-12-31$32,362
Participant contributions at beginning of year2021-12-31$63,847
Participant contributions at end of year2021-12-31$2,591
Participant contributions at beginning of year2021-12-31$1,856
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$25,104
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$509,951
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,456,320
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$2,946,369
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 pooled separate accounts at end of year2021-12-31$3,419,721
Value of interest in pooled separate accounts at beginning of year2021-12-31$2,879,390
Interest on participant loans2021-12-31$2,854
Net investment gain/loss from pooled separate accounts2021-12-31$372,828
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$82,403
Employer contributions (assets) at end of year2021-12-31$1,646
Employer contributions (assets) at beginning of year2021-12-31$1,276
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$109,218
Contract administrator fees2021-12-31$2,635
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 name2021-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2021-12-31581844576
2020 : FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
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$673,369
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$171,542
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$168,304
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$249,947
Value of total assets at end of year2020-12-31$2,946,369
Value of total assets at beginning of year2020-12-31$2,444,542
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$3,238
Total interest from all sources2020-12-31$4,473
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$245,000
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$140,553
Participant contributions at end of year2020-12-31$63,847
Participant contributions at beginning of year2020-12-31$79,019
Participant contributions at end of year2020-12-31$1,856
Participant contributions at beginning of year2020-12-31$2,127
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$23,507
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$501,827
Value of net assets at end of year (total assets less liabilities)2020-12-31$2,946,369
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$2,444,542
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 pooled separate accounts at end of year2020-12-31$2,879,390
Value of interest in pooled separate accounts at beginning of year2020-12-31$2,362,207
Interest on participant loans2020-12-31$4,473
Net investment gain/loss from pooled separate accounts2020-12-31$418,949
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$85,887
Employer contributions (assets) at end of year2020-12-31$1,276
Employer contributions (assets) at beginning of year2020-12-31$1,189
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$168,304
Contract administrator fees2020-12-31$3,238
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 name2020-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2020-12-31581844576
2019 : FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$622,863
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$85,665
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$50,817
Value of total corrective distributions2019-12-31$31,520
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$228,574
Value of total assets at end of year2019-12-31$2,444,542
Value of total assets at beginning of year2019-12-31$1,907,344
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$3,328
Total interest from all sources2019-12-31$5,725
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$190,735
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$145,812
Participant contributions at end of year2019-12-31$79,019
Participant contributions at beginning of year2019-12-31$101,734
Participant contributions at end of year2019-12-31$2,127
Participant contributions at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$537,198
Value of net assets at end of year (total assets less liabilities)2019-12-31$2,444,542
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,907,344
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$2,362,207
Value of interest in pooled separate accounts at beginning of year2019-12-31$1,805,610
Interest on participant loans2019-12-31$5,725
Net investment gain/loss from pooled separate accounts2019-12-31$388,564
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$82,762
Employer contributions (assets) at end of year2019-12-31$1,189
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$50,817
Contract administrator fees2019-12-31$3,328
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2019-12-31581844576
2018 : FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$-36,256
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$295,714
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$291,622
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$121,834
Value of total assets at end of year2018-12-31$1,907,344
Value of total assets at beginning of year2018-12-31$2,239,314
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$4,092
Total interest from all sources2018-12-31$4,610
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$223,932
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$121,827
Participant contributions at end of year2018-12-31$101,734
Participant contributions at beginning of year2018-12-31$87,726
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$7
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-331,970
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,907,344
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$2,239,314
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in pooled separate accounts at end of year2018-12-31$1,805,610
Value of interest in pooled separate accounts at beginning of year2018-12-31$2,151,588
Interest on participant loans2018-12-31$4,610
Net investment gain/loss from pooled separate accounts2018-12-31$-162,700
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$291,622
Contract administrator fees2018-12-31$4,092
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2018-12-31581844576
2017 : FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$12
Total income from all sources (including contributions)2017-12-31$626,378
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$77,507
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$72,724
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$326,296
Value of total assets at end of year2017-12-31$2,239,314
Value of total assets at beginning of year2017-12-31$1,690,455
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$4,783
Total interest from all sources2017-12-31$6,420
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$223,931
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$147,396
Participant contributions at end of year2017-12-31$87,726
Participant contributions at beginning of year2017-12-31$123,498
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$3,704
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$86,340
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$12
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$548,871
Value of net assets at end of year (total assets less liabilities)2017-12-31$2,239,314
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$1,690,443
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$558
Value of interest in pooled separate accounts at end of year2017-12-31$2,151,588
Value of interest in pooled separate accounts at beginning of year2017-12-31$1,562,116
Interest on participant loans2017-12-31$6,420
Net investment gain/loss from pooled separate accounts2017-12-31$293,662
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$92,560
Employer contributions (assets) at end of year2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$1,137
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$72,724
Contract administrator fees2017-12-31$4,225
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2017-12-31581844576
2016 : FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$12
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$328,005
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$135,462
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$122,299
Value of total corrective distributions2016-12-31$8,156
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$230,872
Value of total assets at end of year2016-12-31$1,690,455
Value of total assets at beginning of year2016-12-31$1,497,900
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$5,007
Total interest from all sources2016-12-31$6,039
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$169,044
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$142,620
Participant contributions at end of year2016-12-31$123,498
Participant contributions at beginning of year2016-12-31$113,238
Participant contributions at end of year2016-12-31$3,704
Participant contributions at beginning of year2016-12-31$1,558
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$976
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$12
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$192,543
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,690,443
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,497,900
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$1,462
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$94,468
Value of interest in pooled separate accounts at end of year2016-12-31$1,562,116
Value of interest in pooled separate accounts at beginning of year2016-12-31$1,236,871
Interest on participant loans2016-12-31$6,039
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$51,765
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$51,765
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$2,270
Net investment gain/loss from pooled separate accounts2016-12-31$88,824
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$87,276
Employer contributions (assets) at end of year2016-12-31$1,137
Employer contributions (assets) at beginning of year2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$122,299
Contract administrator fees2016-12-31$3,545
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2016-12-31581844576
2015 : FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$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$584
Total income from all sources (including contributions)2015-12-31$105,968
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$112,961
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$105,443
Value of total corrective distributions2015-12-31$3,652
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$124,371
Value of total assets at end of year2015-12-31$1,497,900
Value of total assets at beginning of year2015-12-31$1,505,477
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$3,866
Total interest from all sources2015-12-31$5,023
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$150,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$122,918
Participant contributions at end of year2015-12-31$113,238
Participant contributions at beginning of year2015-12-31$0
Participant contributions at end of year2015-12-31$1,558
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$900
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$584
Administrative expenses (other) incurred2015-12-31$650
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-6,993
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,497,900
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$1,504,893
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$94,468
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$0
Value of interest in pooled separate accounts at end of year2015-12-31$1,236,871
Value of interest in pooled separate accounts at beginning of year2015-12-31$1,356,760
Interest on participant loans2015-12-31$5,013
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$51,765
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$148,717
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$148,717
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$10
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-1,843
Net investment gain/loss from pooled separate accounts2015-12-31$-21,583
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$553
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$105,443
Contract administrator fees2015-12-31$3,216
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31CERQUEDA, MORGAN & COLLINS, LLP
Accountancy firm EIN2015-12-31581844576

Form 5500 Responses for FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN

2022: FOUTS BROS. INC. 401(K) PROFIT SHARING 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: FOUTS BROS. INC. 401(K) PROFIT SHARING 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: FOUTS BROS. INC. 401(K) PROFIT SHARING 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
2019: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01First time form 5500 has been submittedYes
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan funding arrangement – General assets of the sponsorYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – General assets of the sponsorYes
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: FOUTS BROS. INC. 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92459
Policy instance 1
Insurance contract or identification number92459
Number of Individuals Covered71
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,360
Total amount of fees paid to insurance companyUSD $3,305
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?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 $12,360
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92459
Policy instance 1
Insurance contract or identification number92459
Number of Individuals Covered67
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $12,638
Total amount of fees paid to insurance companyUSD $3,607
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?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 $12,638
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92459
Policy instance 1
Insurance contract or identification number92459
Number of Individuals Covered55
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $10,593
Total amount of fees paid to insurance companyUSD $2,688
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?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 $9,565
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92459
Policy instance 1
Insurance contract or identification number92459
Number of Individuals Covered51
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $10,862
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?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
Amount paid for insurance broker fees8370
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92459
Policy instance 1
Insurance contract or identification number92459
Number of Individuals Covered47
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $11,408
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?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
Amount paid for insurance broker fees8006
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberGA7850
Policy instance 1
Insurance contract or identification numberGA7850
Number of Individuals Covered110
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $41,472
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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?No
Health Insurance Welfare BenefitYes
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 $41,472
Amount paid for insurance broker fees0
Insurance broker namePRITCHARD & JERDEN INC
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05326497
Policy instance 2
Insurance contract or identification numberTM05326497
Number of Individuals Covered262
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $3,431
Total amount of fees paid to insurance companyUSD $3,339
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $57,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,431
Amount paid for insurance broker fees3339
Insurance broker organization code?3
Insurance broker namePRITCHARD & JERDEN INC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92459
Policy instance 1
Insurance contract or identification number92459
Number of Individuals Covered53
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,346
Total amount of fees paid to insurance companyUSD $5,603
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?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 $7,346
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Insurance broker nameMORGAN STANLEY SMITH BARNEY
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92459
Policy instance 1
Insurance contract or identification number92459
Number of Individuals Covered52
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,965
Total amount of fees paid to insurance companyUSD $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 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?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 $5,058
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Insurance broker nameMORGAN STANLEY SMITH BARNEY

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