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401k Plan overview

Plan NamePATRIOT BANK 401K PLAN
Plan identification number 001

PATRIOT BANK 401K PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    PATRIOT BANK has sponsored the creation of one or more 401k plans.

    Company Name:PATRIOT BANK
    Employer identification number (EIN):750341605
    NAIC Classification:522110
    NAIC Description:Commercial Banking

    Additional information about PATRIOT BANK

    Jurisdiction of Incorporation: Florida Department of State Division of Corporations
    Incorporation Date: 2004-07-20
    Company Identification Number: P04000107450
    Legal Registered Office Address: 1815 LITTLE RD.

    TRINITY

    34655

    More information about PATRIOT BANK

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan PATRIOT BANK 401K PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    0012016-01-01
    0012015-01-01
    0012014-01-01DIANNE KIRSCH
    0012013-01-01DIANNE KIRSCH
    0012012-01-01DIANNE KIRSCH
    0012011-01-01DIANNE KIRSCH
    0012009-01-01JANE POE

    Plan Statistics for PATRIOT BANK 401K PLAN

    401k plan membership statisitcs for PATRIOT BANK 401K PLAN

    Measure Date Value
    2016
    Total participants, beginning-of-year2016-01-01122
    Total number of active participants reported on line 7a of the Form 55002016-01-010
    Number of retired or separated participants receiving benefits2016-01-010
    Number of other retired or separated participants entitled to future benefits2016-01-010
    Total of all active and inactive participants2016-01-010
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
    Total participants2016-01-010
    Number of participants with account balances2016-01-010
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
    2015
    Total participants, beginning-of-year2015-01-01340
    Total number of active participants reported on line 7a of the Form 55002015-01-010
    Number of retired or separated participants receiving benefits2015-01-010
    Number of other retired or separated participants entitled to future benefits2015-01-01122
    Total of all active and inactive participants2015-01-01122
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
    Total participants2015-01-01122
    Number of participants with account balances2015-01-01122
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-014
    2014
    Total participants, beginning-of-year2014-01-01315
    Total number of active participants reported on line 7a of the Form 55002014-01-01169
    Number of retired or separated participants receiving benefits2014-01-010
    Number of other retired or separated participants entitled to future benefits2014-01-01171
    Total of all active and inactive participants2014-01-01340
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
    Total participants2014-01-01340
    Number of participants with account balances2014-01-01327
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0131
    2013
    Total participants, beginning-of-year2013-01-01302
    Total number of active participants reported on line 7a of the Form 55002013-01-01231
    Number of retired or separated participants receiving benefits2013-01-010
    Number of other retired or separated participants entitled to future benefits2013-01-0194
    Total of all active and inactive participants2013-01-01325
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
    Total participants2013-01-01325
    Number of participants with account balances2013-01-01301
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0140
    2012
    Total participants, beginning-of-year2012-01-01231
    Total number of active participants reported on line 7a of the Form 55002012-01-01243
    Number of retired or separated participants receiving benefits2012-01-010
    Number of other retired or separated participants entitled to future benefits2012-01-0157
    Total of all active and inactive participants2012-01-01300
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
    Total participants2012-01-01300
    Number of participants with account balances2012-01-01259
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
    2011
    Total participants, beginning-of-year2011-01-01216
    Total number of active participants reported on line 7a of the Form 55002011-01-01201
    Number of retired or separated participants receiving benefits2011-01-010
    Number of other retired or separated participants entitled to future benefits2011-01-0130
    Total of all active and inactive participants2011-01-01231
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
    Total participants2011-01-01231
    Number of participants with account balances2011-01-01183
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
    2009
    Total participants, beginning-of-year2009-01-01182
    Total number of active participants reported on line 7a of the Form 55002009-01-01195
    Number of retired or separated participants receiving benefits2009-01-010
    Number of other retired or separated participants entitled to future benefits2009-01-0128
    Total of all active and inactive participants2009-01-01223
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
    Total participants2009-01-01223
    Number of participants with account balances2009-01-01163
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

    Financial Data on PATRIOT BANK 401K PLAN

    Measure Date Value
    2016
    Total unrealized appreciation/depreciation of assets2016-05-31$0
    Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$0
    Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$0
    Total income from all sources (including contributions)2016-05-31$-37,380
    Total loss/gain on sale of assets2016-05-31$0
    Total of all expenses incurred2016-05-31$1,518,559
    Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-05-31$1,511,097
    Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-05-31$0
    Value of total assets at end of year2016-05-31$0
    Value of total assets at beginning of year2016-05-31$1,555,939
    Total of administrative expenses incurred including professional, contract, advisory and management fees2016-05-31$7,462
    Total interest from all sources2016-05-31$42
    Total dividends received (eg from common stock, registered investment company shares)2016-05-31$0
    Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-05-31Yes
    Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-05-31$0
    Was this plan covered by a fidelity bond2016-05-31Yes
    Value of fidelity bond cover2016-05-31$5,000,000
    If this is an individual account plan, was there a blackout period2016-05-31No
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-05-31$0
    Were there any nonexempt tranactions with any party-in-interest2016-05-31No
    Participant contributions at end of year2016-05-31$0
    Participant contributions at beginning of year2016-05-31$6,425
    Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
    Value of net income/loss2016-05-31$-1,555,939
    Value of net assets at end of year (total assets less liabilities)2016-05-31$0
    Value of net assets at beginning of year (total assets less liabilities)2016-05-31$1,555,939
    Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-05-31No
    Were any loans by the plan or fixed income obligations due to the plan in default2016-05-31No
    Were any leases to which the plan was party in default or uncollectible2016-05-31No
    Investment advisory and management fees2016-05-31$7,462
    Value of interest in registered invesment companies (eg mutual funds) at end of year2016-05-31$0
    Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-05-31$1,109,113
    Interest on participant loans2016-05-31$42
    Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-05-31$0
    Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-05-31$141,513
    Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-05-31$-37,422
    Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-05-31No
    Was there a failure to transmit to the plan any participant contributions2016-05-31No
    Has the plan failed to provide any benefit when due under the plan2016-05-31No
    Assets. Invements in employer securities at end of year2016-05-31$0
    Assets. Invements in employer securities at beginning of year2016-05-31$298,888
    Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-05-31$1,511,097
    Did the plan have assets held for investment2016-05-31No
    Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
    Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-05-31Yes
    Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-05-31Yes
    Opinion of an independent qualified public accountant for this plan2016-05-31Disclaimer
    Accountancy firm name2016-05-31BRIGGS & VESELKA
    Accountancy firm EIN2016-05-31741769118
    2015
    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$0
    Total income from all sources (including contributions)2015-12-31$839,830
    Total loss/gain on sale of assets2015-12-31$0
    Total of all expenses incurred2015-12-31$5,844,945
    Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$5,798,890
    Value of total corrective distributions2015-12-31$25,387
    Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,011,601
    Value of total assets at end of year2015-12-31$1,555,939
    Value of total assets at beginning of year2015-12-31$6,561,054
    Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$20,668
    Total interest from all sources2015-12-31$3,246
    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 year2015-12-31Yes
    Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-12-31$0
    Was this plan covered by a fidelity bond2015-12-31Yes
    Value of fidelity bond cover2015-12-31$5,000,000
    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$724,276
    Participant contributions at end of year2015-12-31$6,425
    Participant contributions at beginning of year2015-12-31$90,512
    Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$144,427
    Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
    Value of net income/loss2015-12-31$-5,005,115
    Value of net assets at end of year (total assets less liabilities)2015-12-31$1,555,939
    Value of net assets at beginning of year (total assets less liabilities)2015-12-31$6,561,054
    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
    Investment advisory and management fees2015-12-31$20,668
    Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$1,109,113
    Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$4,850,563
    Interest on participant loans2015-12-31$3,246
    Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$141,513
    Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$1,062,155
    Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-175,017
    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
    Assets. Invements in employer securities at end of year2015-12-31$298,888
    Assets. Invements in employer securities at beginning of year2015-12-31$392,558
    Contributions received in cash from employer2015-12-31$142,898
    Employer contributions (assets) at end of year2015-12-31$0
    Employer contributions (assets) at beginning of year2015-12-31$165,266
    Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$5,798,890
    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 name2015-12-31BRIGGS & VESELKA CO.
    Accountancy firm EIN2015-12-31741769118
    2014
    Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$32,512
    Total unrealized appreciation/depreciation of assets2014-12-31$32,512
    Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
    Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$11,764
    Total income from all sources (including contributions)2014-12-31$1,751,590
    Total loss/gain on sale of assets2014-12-31$0
    Total of all expenses incurred2014-12-31$1,361,342
    Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,354,527
    Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,447,752
    Value of total assets at end of year2014-12-31$6,561,054
    Value of total assets at beginning of year2014-12-31$6,182,570
    Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$6,815
    Total interest from all sources2014-12-31$2,426
    Total dividends received (eg from common stock, registered investment company shares)2014-12-31$382,398
    Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
    Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$382,398
    Was this plan covered by a fidelity bond2014-12-31Yes
    Value of fidelity bond cover2014-12-31$10,000,000
    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$979,835
    Participant contributions at end of year2014-12-31$90,512
    Participant contributions at beginning of year2014-12-31$83,009
    Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$302,519
    Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$0
    Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$11,764
    Other income not declared elsewhere2014-12-31$285
    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$390,248
    Value of net assets at end of year (total assets less liabilities)2014-12-31$6,561,054
    Value of net assets at beginning of year (total assets less liabilities)2014-12-31$6,170,806
    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
    Investment advisory and management fees2014-12-31$6,815
    Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$4,850,563
    Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$4,586,829
    Interest on participant loans2014-12-31$2,426
    Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$1,062,155
    Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$923,170
    Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$-113,783
    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
    Assets. Invements in employer securities at end of year2014-12-31$392,558
    Assets. Invements in employer securities at beginning of year2014-12-31$338,550
    Contributions received in cash from employer2014-12-31$165,398
    Employer contributions (assets) at end of year2014-12-31$165,266
    Employer contributions (assets) at beginning of year2014-12-31$251,012
    Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,354,527
    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 name2014-12-31HARPER & PEARSON COMPANY, P.C.
    Accountancy firm EIN2014-12-31741695589
    2013
    Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$25,168
    Total unrealized appreciation/depreciation of assets2013-12-31$25,168
    Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$11,764
    Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$16,234
    Total income from all sources (including contributions)2013-12-31$2,327,667
    Total loss/gain on sale of assets2013-12-31$0
    Total of all expenses incurred2013-12-31$781,781
    Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$775,255
    Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,515,174
    Value of total assets at end of year2013-12-31$6,182,570
    Value of total assets at beginning of year2013-12-31$4,641,154
    Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$6,526
    Total interest from all sources2013-12-31$2,641
    Total dividends received (eg from common stock, registered investment company shares)2013-12-31$196,811
    Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
    Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$196,811
    Was this plan covered by a fidelity bond2013-12-31Yes
    Value of fidelity bond cover2013-12-31$5,000,000
    If this is an individual account plan, was there a blackout period2013-12-31No
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
    Were there any nonexempt tranactions with any party-in-interest2013-12-31No
    Contributions received from participants2013-12-31$1,215,547
    Participant contributions at end of year2013-12-31$83,009
    Participant contributions at beginning of year2013-12-31$77,635
    Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$48,615
    Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$11,764
    Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$16,234
    Other income not declared elsewhere2013-12-31$4,469
    Total non interest bearing cash at end of year2013-12-31$0
    Total non interest bearing cash at beginning of year2013-12-31$200
    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$1,545,886
    Value of net assets at end of year (total assets less liabilities)2013-12-31$6,170,806
    Value of net assets at beginning of year (total assets less liabilities)2013-12-31$4,624,920
    Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
    Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
    Were any leases to which the plan was party in default or uncollectible2013-12-31No
    Investment advisory and management fees2013-12-31$6,526
    Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$4,586,829
    Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$2,951,781
    Interest on participant loans2013-12-31$2,641
    Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$923,170
    Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$983,930
    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
    Assets. Invements in employer securities at end of year2013-12-31$338,550
    Assets. Invements in employer securities at beginning of year2013-12-31$305,000
    Contributions received in cash from employer2013-12-31$251,012
    Employer contributions (assets) at end of year2013-12-31$251,012
    Employer contributions (assets) at beginning of year2013-12-31$322,608
    Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$775,255
    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 name2013-12-31HARPER & PEARSON COMPANY, P.C.
    Accountancy firm EIN2013-12-31741695589
    2012
    Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$15,250
    Total unrealized appreciation/depreciation of assets2012-12-31$15,250
    Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$16,234
    Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$17,858
    Total income from all sources (including contributions)2012-12-31$1,837,260
    Total loss/gain on sale of assets2012-12-31$0
    Total of all expenses incurred2012-12-31$424,032
    Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$421,251
    Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,479,548
    Value of total assets at end of year2012-12-31$4,641,154
    Value of total assets at beginning of year2012-12-31$3,229,550
    Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$2,781
    Total interest from all sources2012-12-31$1,773
    Total dividends received (eg from common stock, registered investment company shares)2012-12-31$94,823
    Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
    Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$94,823
    Was this plan covered by a fidelity bond2012-12-31Yes
    Value of fidelity bond cover2012-12-31$5,000,000
    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$0
    Were there any nonexempt tranactions with any party-in-interest2012-12-31No
    Contributions received from participants2012-12-31$1,095,681
    Participant contributions at end of year2012-12-31$77,635
    Participant contributions at beginning of year2012-12-31$33,382
    Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$61,259
    Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$16,234
    Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$17,858
    Other income not declared elsewhere2012-12-31$1,623
    Total non interest bearing cash at end of year2012-12-31$200
    Total non interest bearing cash at beginning of year2012-12-31$196
    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$1,413,228
    Value of net assets at end of year (total assets less liabilities)2012-12-31$4,624,920
    Value of net assets at beginning of year (total assets less liabilities)2012-12-31$3,211,692
    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
    Investment advisory and management fees2012-12-31$2,781
    Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$2,951,781
    Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$2,229,969
    Interest on participant loans2012-12-31$1,773
    Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$983,930
    Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$676,253
    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
    Assets. Invements in employer securities at end of year2012-12-31$305,000
    Assets. Invements in employer securities at beginning of year2012-12-31$289,750
    Contributions received in cash from employer2012-12-31$322,608
    Employer contributions (assets) at end of year2012-12-31$322,608
    Employer contributions (assets) at beginning of year2012-12-31$0
    Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$421,251
    Did the plan have assets held for investment2012-12-31Yes
    Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
    Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
    Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
    Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
    Accountancy firm name2012-12-31HARPER & PEARSON COMPANY, P.C.
    Accountancy firm EIN2012-12-31741695589
    2011
    Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$-45,750
    Total unrealized appreciation/depreciation of assets2011-12-31$-45,750
    Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$17,858
    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$800,274
    Total loss/gain on sale of assets2011-12-31$0
    Total of all expenses incurred2011-12-31$656,799
    Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$640,793
    Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$891,641
    Value of total assets at end of year2011-12-31$3,229,550
    Value of total assets at beginning of year2011-12-31$3,068,217
    Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$16,006
    Total interest from all sources2011-12-31$6,161
    Total dividends received (eg from common stock, registered investment company shares)2011-12-31$25,638
    Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
    Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$25,638
    Was this plan covered by a fidelity bond2011-12-31Yes
    Value of fidelity bond cover2011-12-31$5,000,000
    If this is an individual account plan, was there a blackout period2011-12-31Yes
    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$891,563
    Participant contributions at end of year2011-12-31$33,382
    Participant contributions at beginning of year2011-12-31$14,288
    Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$78
    Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$17,858
    Other income not declared elsewhere2011-12-31$-28,396
    Total non interest bearing cash at end of year2011-12-31$196
    Total non interest bearing cash at beginning of year2011-12-31$59
    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$143,475
    Value of net assets at end of year (total assets less liabilities)2011-12-31$3,211,692
    Value of net assets at beginning of year (total assets less liabilities)2011-12-31$3,068,217
    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 registered invesment companies (eg mutual funds) at end of year2011-12-31$2,229,969
    Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$2,488,051
    Interest on participant loans2011-12-31$599
    Interest earned on other investments2011-12-31$5,562
    Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$676,253
    Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$230,319
    Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-49,020
    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
    Assets. Invements in employer securities at end of year2011-12-31$289,750
    Assets. Invements in employer securities at beginning of year2011-12-31$335,500
    Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$640,793
    Contract administrator fees2011-12-31$16,006
    Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31Yes
    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 name2011-12-31HARPER & PEARSON COMPANY, P.C.
    Accountancy firm EIN2011-12-31741695589
    2010
    Total unrealized appreciation/depreciation of assets2010-12-31$0
    Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
    Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
    Total income from all sources (including contributions)2010-12-31$1,172,314
    Total loss/gain on sale of assets2010-12-31$0
    Total of all expenses incurred2010-12-31$416,063
    Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$398,687
    Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$859,946
    Value of total assets at end of year2010-12-31$3,068,217
    Value of total assets at beginning of year2010-12-31$2,311,966
    Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$17,376
    Total interest from all sources2010-12-31$478
    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$3,000,000
    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$784,174
    Participant contributions at end of year2010-12-31$14,288
    Participant contributions at beginning of year2010-12-31$7,517
    Participant contributions at end of year2010-12-31$0
    Participant contributions at beginning of year2010-12-31$2,008
    Assets. Other investments not covered elsewhere at end of year2010-12-31$0
    Assets. Other investments not covered elsewhere at beginning of year2010-12-31$2,371
    Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$75,772
    Other income not declared elsewhere2010-12-31$20,440
    Total non interest bearing cash at end of year2010-12-31$59
    Total non interest bearing cash at beginning of year2010-12-31$59
    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$756,251
    Value of net assets at end of year (total assets less liabilities)2010-12-31$3,068,217
    Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,311,966
    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 registered invesment companies (eg mutual funds) at end of year2010-12-31$2,488,051
    Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$1,764,059
    Interest on participant loans2010-12-31$478
    Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$230,319
    Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$209,602
    Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$291,450
    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
    Assets. Invements in employer securities at end of year2010-12-31$335,500
    Assets. Invements in employer securities at beginning of year2010-12-31$326,350
    Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$398,687
    Contract administrator fees2010-12-31$17,376
    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 name2010-12-31HARPER & PEARSON COMPANY, P.C.
    Accountancy firm EIN2010-12-31741695589
    2009
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

    Form 5500 Responses

    2016
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Submission has been amendedNo
    2016-01-01This submission is the final filingYes
    2016-01-01This return/report is a short plan year return/report (less than 12 months)Yes
    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
    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
    2014
    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 – InsuranceYes
    2014-01-01Plan benefit arrangement - TrustYes
    2013
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Submission has been amendedNo
    2013-01-01This submission is the final filingNo
    2013-01-01This return/report is a short plan year return/report (less than 12 months)No
    2013-01-01Plan is a collectively bargained planNo
    2013-01-01Plan funding arrangement – InsuranceYes
    2013-01-01Plan funding arrangement – TrustYes
    2013-01-01Plan benefit arrangement – InsuranceYes
    2013-01-01Plan benefit arrangement - TrustYes
    2012
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Submission has been amendedNo
    2012-01-01This submission is the final filingNo
    2012-01-01This return/report is a short plan year return/report (less than 12 months)No
    2012-01-01Plan is a collectively bargained planNo
    2012-01-01Plan funding arrangement – InsuranceYes
    2012-01-01Plan funding arrangement – TrustYes
    2012-01-01Plan benefit arrangement – InsuranceYes
    2012-01-01Plan benefit arrangement - TrustYes
    2011
    2011-01-01Type of plan entitySingle employer plan
    2011-01-01Submission has been amendedNo
    2011-01-01This submission is the final filingNo
    2011-01-01This return/report is a short plan year return/report (less than 12 months)No
    2011-01-01Plan is a collectively bargained planNo
    2011-01-01Plan funding arrangement – InsuranceYes
    2011-01-01Plan funding arrangement – TrustYes
    2011-01-01Plan benefit arrangement – InsuranceYes
    2011-01-01Plan benefit arrangement - TrustYes
    2009
    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 – InsuranceYes
    2009-01-01Plan benefit arrangement - TrustYes

    Insurance Providers Used on plan

    HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
    Policy contract numberGA-827115
    Policy instance 1
    Insurance contract or identification numberGA-827115
    Number of Individuals Covered0
    Insurance policy start date2016-01-01
    Insurance policy end date2016-05-02
    Total amount of commissions paid to insurance brokerUSD $3,468
    Total amount of fees paid to insurance companyUSD $578
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,468
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    Insurance broker nameMALCOLM THOMPSON & ASSOCIATES
    HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
    Policy contract number827115
    Policy instance 1
    Insurance contract or identification number827115
    Number of Individuals Covered122
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $17,850
    Total amount of fees paid to insurance companyUSD $5,361
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,850
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH
    HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
    Policy contract number827115
    Policy instance 1
    Insurance contract or identification number827115
    Number of Individuals Covered327
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $16,604
    Total amount of fees paid to insurance companyUSD $4,994
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $16,604
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH
    HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
    Policy contract number827115
    Policy instance 1
    Insurance contract or identification number827115
    Number of Individuals Covered301
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $13,661
    Total amount of fees paid to insurance companyUSD $4,096
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,661
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH
    HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
    Policy contract number827115
    Policy instance 1
    Insurance contract or identification number827115
    Number of Individuals Covered259
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $6,499
    Total amount of fees paid to insurance companyUSD $2,839
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,499
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerN/A
    Insurance broker organization code?3
    Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH
    JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
    Policy contract number55756
    Policy instance 1
    Insurance contract or identification number55756
    Number of Individuals Covered0
    Insurance policy start date2011-01-01
    Insurance policy end date2011-10-03
    Total amount of commissions paid to insurance brokerUSD $11,085
    Total amount of fees paid to insurance companyUSD $2,869
    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?Yes
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
    Policy contract number827115
    Policy instance 2
    Insurance contract or identification number827115
    Number of Individuals Covered183
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $20,873
    Total amount of fees paid to insurance companyUSD $8,000
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
    Policy contract number55756
    Policy instance 1
    Insurance contract or identification number55756
    Number of Individuals Covered157
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $10,975
    Total amount of fees paid to insurance companyUSD $3,547
    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?Yes
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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