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LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 401k Plan overview

Plan NameLEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST
Plan identification number 001

LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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.

401k Sponsoring company profile

PAY-LESS SUPERMARKET, INC has sponsored the creation of one or more 401k plans.

Company Name:PAY-LESS SUPERMARKET, INC
Employer identification number (EIN):720547406
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-01-01ALLISON ROYSTER ALLISON ROYSTER2018-03-14
0012016-01-01ALLISON ROYSTER
0012016-01-01ALLISON ROYSTER
0012016-01-01
0012016-01-01
0012015-01-01
0012014-01-01MARCY J LEBLANC, SR.
0012013-01-01MARCY J LEBLANC , SR
0012012-01-01MARCY J LEBLANC , SR
0012011-01-01MARCY J LEBLANC , SR
0012010-01-01MARCY J LEBLANC , SR
0012009-01-01MARCY J LEBLANC , SR

Plan Statistics for LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST

401k plan membership statisitcs for LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST

Measure Date Value
2017: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-01356
Total number of active participants reported on line 7a of the Form 55002017-01-010
Total of all active and inactive participants2017-01-010
Total participants2017-01-010
2016: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-01354
Total number of active participants reported on line 7a of the Form 55002016-01-01312
Number of other retired or separated participants entitled to future benefits2016-01-0144
Total of all active and inactive participants2016-01-01356
Total participants2016-01-01356
Number of participants with account balances2016-01-01169
2015: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-01336
Total number of active participants reported on line 7a of the Form 55002015-01-01307
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0121
Total of all active and inactive participants2015-01-01328
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01328
Number of participants with account balances2015-01-01136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-01312
Total number of active participants reported on line 7a of the Form 55002014-01-01272
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0118
Total of all active and inactive participants2014-01-01290
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01290
Number of participants with account balances2014-01-01130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-01277
Total number of active participants reported on line 7a of the Form 55002013-01-01319
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0118
Total of all active and inactive participants2013-01-01337
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01337
Number of participants with account balances2013-01-01119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-01297
Total number of active participants reported on line 7a of the Form 55002012-01-01256
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0121
Total of all active and inactive participants2012-01-01277
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01277
Number of participants with account balances2012-01-01122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-01268
Total number of active participants reported on line 7a of the Form 55002011-01-01242
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0113
Total of all active and inactive participants2011-01-01255
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01255
Number of participants with account balances2011-01-01114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-01274
Total number of active participants reported on line 7a of the Form 55002010-01-01241
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0110
Total of all active and inactive participants2010-01-01251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01251
Number of participants with account balances2010-01-01118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-01217
Total number of active participants reported on line 7a of the Form 55002009-01-01202
Number of retired or separated participants receiving benefits2009-01-0116
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01218
Number of participants with account balances2009-01-01108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST

Measure Date Value
2017 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-02-15$0
Total transfer of assets from this plan2017-02-15$3,416,622
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-02-15$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-02-15$0
Total income from all sources (including contributions)2017-02-15$128,423
Total loss/gain on sale of assets2017-02-15$0
Total of all expenses incurred2017-02-15$2,526,819
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-02-15$2,525,679
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-02-15$0
Value of total assets at end of year2017-02-15$0
Value of total assets at beginning of year2017-02-15$5,815,018
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-02-15$1,140
Total interest from all sources2017-02-15$0
Total dividends received (eg from common stock, registered investment company shares)2017-02-15$1,495
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-02-15Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-02-15$0
Total dividends received from registered investment company shares (eg mutual funds)2017-02-15$1,495
Was this plan covered by a fidelity bond2017-02-15Yes
Value of fidelity bond cover2017-02-15$500,000
If this is an individual account plan, was there a blackout period2017-02-15No
Were there any nonexempt tranactions with any party-in-interest2017-02-15No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-02-15No
Value of net income/loss2017-02-15$-2,398,396
Value of net assets at end of year (total assets less liabilities)2017-02-15$0
Value of net assets at beginning of year (total assets less liabilities)2017-02-15$5,815,018
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-02-15No
Were any loans by the plan or fixed income obligations due to the plan in default2017-02-15No
Were any leases to which the plan was party in default or uncollectible2017-02-15No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-02-15$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-02-15$5,815,013
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-02-15$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-02-15$5
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-02-15$5
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-02-15$126,928
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-02-15No
Was there a failure to transmit to the plan any participant contributions2017-02-15No
Has the plan failed to provide any benefit when due under the plan2017-02-15No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-02-15$2,525,679
Contract administrator fees2017-02-15$1,140
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-02-15No
Did the plan have assets held for investment2017-02-15No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-02-15No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-02-15Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-02-15Yes
Opinion of an independent qualified public accountant for this plan2017-02-15Disclaimer
Accountancy firm name2017-02-15POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2017-02-15721202445
2016 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2016 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$10,898
Total income from all sources (including contributions)2016-12-31$891,801
Total of all expenses incurred2016-12-31$757,241
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$756,221
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$818,424
Value of total assets at end of year2016-12-31$5,815,018
Value of total assets at beginning of year2016-12-31$5,691,356
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,020
Total interest from all sources2016-12-31$5
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$94,944
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$94,944
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$419,049
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$155,981
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$10,898
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$134,560
Value of net assets at end of year (total assets less liabilities)2016-12-31$5,815,018
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$5,680,458
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$5,815,013
Value of interest in pooled separate accounts at beginning of year2016-12-31$5,691,356
Value of interest in common/collective trusts at end of year2016-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$5
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$5
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$343,643
Net investment gain/loss from pooled separate accounts2016-12-31$-365,215
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$243,394
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$756,221
Contract administrator fees2016-12-31$1,020
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
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 name2016-12-31POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2016-12-31721202445
2015 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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$10,898
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$10,533
Total income from all sources (including contributions)2015-12-31$675,911
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$185,945
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$185,945
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$619,155
Value of total assets at end of year2015-12-31$5,691,356
Value of total assets at beginning of year2015-12-31$5,201,025
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$0
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
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$399,081
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$10,898
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$10,533
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$489,966
Value of net assets at end of year (total assets less liabilities)2015-12-31$5,680,458
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$5,190,492
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 pooled separate accounts at end of year2015-12-31$5,691,356
Value of interest in pooled separate accounts at beginning of year2015-12-31$5,201,025
Net investment gain/loss from pooled separate accounts2015-12-31$56,756
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$220,074
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$185,945
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 name2015-12-31POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2015-12-31721202445
2014 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$10,533
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$8,515
Total income from all sources (including contributions)2014-12-31$878,244
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$361,676
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$361,676
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$560,012
Value of total assets at end of year2014-12-31$5,201,025
Value of total assets at beginning of year2014-12-31$4,682,439
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$0
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$358,723
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$10,533
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$8,515
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$516,568
Value of net assets at end of year (total assets less liabilities)2014-12-31$5,190,492
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$4,673,924
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in pooled separate accounts at end of year2014-12-31$5,201,025
Value of interest in pooled separate accounts at beginning of year2014-12-31$4,682,439
Net investment gain/loss from pooled separate accounts2014-12-31$318,232
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$201,289
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$361,676
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2014-12-31721202445
2013 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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$8,515
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$1,377,441
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$409,063
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$409,063
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$726,075
Value of total assets at end of year2013-12-31$4,682,439
Value of total assets at beginning of year2013-12-31$3,705,546
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$0
Total interest from all sources2013-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
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$354,097
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$178,346
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$8,515
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$968,378
Value of net assets at end of year (total assets less liabilities)2013-12-31$4,673,924
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$3,705,546
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
Value of interest in pooled separate accounts at end of year2013-12-31$4,682,439
Value of interest in pooled separate accounts at beginning of year2013-12-31$3,705,546
Net investment gain/loss from pooled separate accounts2013-12-31$651,366
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$193,632
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$409,063
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 name2013-12-31POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2013-12-31721202445
2012 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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$974,519
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$66,065
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$66,065
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$592,235
Value of total assets at end of year2012-12-31$3,705,546
Value of total assets at beginning of year2012-12-31$2,797,092
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$0
Total interest from all sources2012-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$300,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$1
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$357,423
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$42,155
Total non interest bearing cash at end of year2012-12-31$0
Total non interest bearing cash at beginning of year2012-12-31$8
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$908,454
Value of net assets at end of year (total assets less liabilities)2012-12-31$3,705,546
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$2,797,092
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$3,705,546
Value of interest in pooled separate accounts at beginning of year2012-12-31$2,797,084
Net investment gain/loss from pooled separate accounts2012-12-31$382,284
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$192,657
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$66,065
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 name2012-12-31POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2012-12-31721202445
2011 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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$457,350
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$106,944
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$106,944
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$541,426
Value of total assets at end of year2011-12-31$2,797,092
Value of total assets at beginning of year2011-12-31$2,446,686
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$0
Total interest from all sources2011-12-31$0
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$349,642
Total non interest bearing cash at end of year2011-12-31$8
Total non interest bearing cash at beginning of year2011-12-31$8
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$350,406
Value of net assets at end of year (total assets less liabilities)2011-12-31$2,797,092
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$2,446,686
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$2,797,084
Value of interest in pooled separate accounts at beginning of year2011-12-31$2,446,678
Net investment gain/loss from pooled separate accounts2011-12-31$-84,076
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$191,784
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$106,944
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 name2011-12-31POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2011-12-31721202445
2010 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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$7,832
Total income from all sources (including contributions)2010-12-31$777,618
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$58,823
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$58,823
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$501,744
Value of total assets at end of year2010-12-31$2,446,686
Value of total assets at beginning of year2010-12-31$1,735,723
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$0
Total interest from all sources2010-12-31$0
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$150,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$325,650
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$7,832
Total non interest bearing cash at end of year2010-12-31$8
Total non interest bearing cash at beginning of year2010-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$718,795
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,446,686
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$1,727,891
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$2,446,678
Value of interest in pooled separate accounts at beginning of year2010-12-31$1,735,723
Net investment gain/loss from pooled separate accounts2010-12-31$275,874
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$176,094
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$58,823
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 name2010-12-31POSTLETHWAITE & NETTERVILLE
Accountancy firm EIN2010-12-31721202445
2009 : LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST

2017: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedYes
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: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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 - TrustYes
2014: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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 - TrustYes
2012: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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 - TrustYes
2011: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 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 - TrustYes
2010: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: LEBLANC'S PAY-LESS FOOD STORES 401K PLAN AND TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan 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 number74284
Policy instance 1
Insurance contract or identification number74284
Number of Individuals Covered145
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $16,547
Total amount of fees paid to insurance companyUSD $23
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 $13,778
Insurance broker organization code?7
Amount paid for insurance broker fees23
Additional information about fees paid to insurance brokerOTHER ALLOWANCES
Insurance broker nameARS RETIREMENT CORP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number74284
Policy instance 1
Insurance contract or identification number74284
Number of Individuals Covered137
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $14,905
Total amount of fees paid to insurance companyUSD $31
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 $12,418
Insurance broker organization code?7
Amount paid for insurance broker fees31
Additional information about fees paid to insurance brokerOTHER ALLOWANCES
Insurance broker nameARS RETIREMENT CORP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number74284
Policy instance 1
Insurance contract or identification number74284
Number of Individuals Covered119
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $12,364
Total amount of fees paid to insurance companyUSD $21
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 $10,302
Insurance broker organization code?7
Amount paid for insurance broker fees21
Additional information about fees paid to insurance brokerOTHER ALLOWANCES
Insurance broker nameARS RETIREMENT CORP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number74284
Policy instance 1
Insurance contract or identification number74284
Number of Individuals Covered125
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,611
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 $8,008
Insurance broker organization code?7
Insurance broker nameARS RETIREMENT CORP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number74284
Policy instance 1
Insurance contract or identification number74284
Number of Individuals Covered115
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,971
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number74284
Policy instance 1
Insurance contract or identification number74284
Number of Individuals Covered120
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,975
Total amount of fees paid to insurance companyUSD $29
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 $1,507
Insurance broker organization code?7
Amount paid for insurance broker fees29
Additional information about fees paid to insurance brokerOTHER ALLOWANCES
Insurance broker nameCAPITAL ONE INVESTMENT SERVICES LLC

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