401k Plan data: TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN plan

TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN 401k Plan overview

Plan Name	TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN
Plan identification number	501

TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

TERRY JOHNSON INSURANCE AGENCY INC has sponsored the creation of one or more 401k plans.

Company Name: TERRY JOHNSON INSURANCE AGENCY INC

Employer identification number (EIN): 621149759

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-11-01 TERRY WARREN JOHNSON II
501 2014-11-01 TERRY WARREN JOHNSON II
501 2014-01-01 TERRY WARREN JOHNSON II
501 2014-01-01 TERRY WARREN JOHNSON II
501 2014-01-01 TERRY WARREN JOHNSON II 2015-07-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2014-11-01	TERRY WARREN JOHNSON II
501	2014-11-01	TERRY WARREN JOHNSON II
501	2014-01-01	TERRY WARREN JOHNSON II
501	2014-01-01	TERRY WARREN JOHNSON II
501	2014-01-01	TERRY WARREN JOHNSON II	2015-07-10

Plan Statistics for TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN

401k plan membership statisitcs for TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN

Measure Date Value
2014: TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-11-01 2
Total number of active participants reported on line 7a of the Form 5500 2014-11-01 0
Number of retired or separated participants receiving benefits 2014-11-01 0
Number of other retired or separated participants entitled to future benefits 2014-11-01 0
Total of all active and inactive participants 2014-11-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-11-01 0
Total participants 2014-11-01 0
Number of participants with account balances 2014-11-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-11-01 0
Total participants, beginning-of-year 2014-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2014: TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-11-01	2
Total number of active participants reported on line 7a of the Form 5500	2014-11-01	0
Number of retired or separated participants receiving benefits	2014-11-01	0
Number of other retired or separated participants entitled to future benefits	2014-11-01	0
Total of all active and inactive participants	2014-11-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-11-01	0
Total participants	2014-11-01	0
Number of participants with account balances	2014-11-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-11-01	0
Total participants, beginning-of-year	2014-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN

Measure	Date	Value
2015 : TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-10-31	$0
Total plan liabilities at beginning of year	2015-10-31	$0
Total income from all sources	2015-10-31	$25,013
Expenses. Total of all expenses incurred	2015-10-31	$25,013
Benefits paid (including direct rollovers)	2015-10-31	$8,189
Total plan assets at end of year	2015-10-31	$0
Total plan assets at beginning of year	2015-10-31	$0
Expenses. Other expenses not covered elsewhere	2015-10-31	$11,924
Net plan assets at end of year (total assets less liabilities)	2015-10-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-10-31	$0
Total contributions received or receivable from employer(s)	2015-10-31	$25,013
Expenses. Administrative service providers (salaries,fees and commissions)	2015-10-31	$4,900
2014 : TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$1,967
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$1,480
Total plan assets at end of year	2014-12-31	$487
Total plan assets at beginning of year	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$1,480
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$-1,480
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$1,480

Form 5500 Responses for TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN

2014: TERRY JOHNSON INSURANCE AGCY EMPLOYEE GROUP HEALTH PLAN 2014 form 5500 responses
2014-11-01	Type of plan entity	Single employer plan
2014-11-01	First time form 5500 has been submitted	Yes
2014-11-01	Plan funding arrangement – Insurance	Yes
2014-11-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	TERRY JOHNSON INSURANCE AGENCY INC
Employer identification number (EIN):	621149759
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages