401k Plan data: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN plan

FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN
Plan identification number	001

FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
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

FOOTHILL VILLAGE SPORTS DEN, INC. has sponsored the creation of one or more 401k plans.

Company Name: FOOTHILL VILLAGE SPORTS DEN, INC.

Employer identification number (EIN): 870295668

NAIC Classification: 451110
NAIC Description: Sporting Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-07-01 PAUL GARDNER PAUL GARDNER 2017-03-12
001 2014-07-01 E. PAUL GARDNER E. PAUL GARDNER 2016-04-11
001 2013-07-01 PAUL GARDNER PAUL GARDNER 2015-04-15
001 2012-07-01 E. PAUL GARDNER E. PAUL GARDNER 2014-03-04
001 2011-07-01 E. PAUL GARDNER E. PAUL GARDNER 2013-04-12
001 2009-07-01 PAUL GARDNER PAUL GARDNER 2011-04-08
001 2009-07-01 E. PAUL GARDNER E. PAUL GARDNER 2011-04-07

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-07-01	PAUL GARDNER	PAUL GARDNER	2017-03-12
001	2014-07-01	E. PAUL GARDNER	E. PAUL GARDNER	2016-04-11
001	2013-07-01	PAUL GARDNER	PAUL GARDNER	2015-04-15
001	2012-07-01	E. PAUL GARDNER	E. PAUL GARDNER	2014-03-04
001	2011-07-01	E. PAUL GARDNER	E. PAUL GARDNER	2013-04-12
001	2009-07-01	PAUL GARDNER	PAUL GARDNER	2011-04-08
001	2009-07-01	E. PAUL GARDNER	E. PAUL GARDNER	2011-04-07

Plan Statistics for FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN

Measure Date Value
2015: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 13
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 0
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 0
Number of participants with account balances 2015-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
2014: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 13
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 10
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 3
Total of all active and inactive participants 2014-07-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 13
Number of participants with account balances 2014-07-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 0
2013: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 13
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 11
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 2
Total of all active and inactive participants 2013-07-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 0
Total participants 2013-07-01 13
Number of participants with account balances 2013-07-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 0
2012: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 13
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 11
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 2
Total of all active and inactive participants 2012-07-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 13
Number of participants with account balances 2012-07-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
2011: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 13
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 11
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 2
Total of all active and inactive participants 2011-07-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 13
Number of participants with account balances 2011-07-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2009: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 11
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 10
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 1
Total of all active and inactive participants 2009-07-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 0
Total participants 2009-07-01 11
Number of participants with account balances 2009-07-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2015: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	13
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	0
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	0
Number of participants with account balances	2015-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
2014: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	13
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	10
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	3
Total of all active and inactive participants	2014-07-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	13
Number of participants with account balances	2014-07-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	0
2013: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	13
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	11
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	2
Total of all active and inactive participants	2013-07-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	0
Total participants	2013-07-01	13
Number of participants with account balances	2013-07-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	0
2012: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	13
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	11
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	2
Total of all active and inactive participants	2012-07-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	13
Number of participants with account balances	2012-07-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
2011: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	13
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	11
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	2
Total of all active and inactive participants	2011-07-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	13
Number of participants with account balances	2011-07-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2009: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	11
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	10
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	1
Total of all active and inactive participants	2009-07-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	0
Total participants	2009-07-01	11
Number of participants with account balances	2009-07-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Financial Data on FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN

Measure	Date	Value
2016 : FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-06-30	$0
Total plan liabilities at end of year	2016-06-30	$0
Total plan liabilities at beginning of year	2016-06-30	$0
Total income from all sources	2016-06-30	$-17,278
Expenses. Total of all expenses incurred	2016-06-30	$342,260
Benefits paid (including direct rollovers)	2016-06-30	$340,838
Total plan assets at end of year	2016-06-30	$0
Total plan assets at beginning of year	2016-06-30	$359,538
Total contributions received or receivable from participants	2016-06-30	$0
Expenses. Other expenses not covered elsewhere	2016-06-30	$0
Contributions received from other sources (not participants or employers)	2016-06-30	$0
Other income received	2016-06-30	$-17,278
Noncash contributions received	2016-06-30	$0
Net income (gross income less expenses)	2016-06-30	$-359,538
Net plan assets at end of year (total assets less liabilities)	2016-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-06-30	$359,538
Total contributions received or receivable from employer(s)	2016-06-30	$0
Value of certain deemed distributions of participant loans	2016-06-30	$0
Value of corrective distributions	2016-06-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-06-30	$1,422
2015 : FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-06-30	$0
Total plan liabilities at end of year	2015-06-30	$0
Total plan liabilities at beginning of year	2015-06-30	$0
Total income from all sources	2015-06-30	$7,999
Expenses. Total of all expenses incurred	2015-06-30	$1,767
Benefits paid (including direct rollovers)	2015-06-30	$0
Total plan assets at end of year	2015-06-30	$359,538
Total plan assets at beginning of year	2015-06-30	$353,306
Total contributions received or receivable from participants	2015-06-30	$0
Expenses. Other expenses not covered elsewhere	2015-06-30	$0
Contributions received from other sources (not participants or employers)	2015-06-30	$0
Other income received	2015-06-30	$7,999
Noncash contributions received	2015-06-30	$0
Net income (gross income less expenses)	2015-06-30	$6,232
Net plan assets at end of year (total assets less liabilities)	2015-06-30	$359,538
Net plan assets at beginning of year (total assets less liabilities)	2015-06-30	$353,306
Total contributions received or receivable from employer(s)	2015-06-30	$0
Value of certain deemed distributions of participant loans	2015-06-30	$0
Value of corrective distributions	2015-06-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-06-30	$1,767
2014 : FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan	2014-06-30	$0
Total plan liabilities at end of year	2014-06-30	$0
Total plan liabilities at beginning of year	2014-06-30	$0
Total income from all sources	2014-06-30	$58,403
Expenses. Total of all expenses incurred	2014-06-30	$1,680
Benefits paid (including direct rollovers)	2014-06-30	$0
Total plan assets at end of year	2014-06-30	$353,306
Total plan assets at beginning of year	2014-06-30	$296,583
Total contributions received or receivable from participants	2014-06-30	$0
Expenses. Other expenses not covered elsewhere	2014-06-30	$0
Contributions received from other sources (not participants or employers)	2014-06-30	$0
Other income received	2014-06-30	$58,403
Noncash contributions received	2014-06-30	$0
Net income (gross income less expenses)	2014-06-30	$56,723
Net plan assets at end of year (total assets less liabilities)	2014-06-30	$353,306
Net plan assets at beginning of year (total assets less liabilities)	2014-06-30	$296,583
Total contributions received or receivable from employer(s)	2014-06-30	$0
Value of certain deemed distributions of participant loans	2014-06-30	$0
Value of corrective distributions	2014-06-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-06-30	$1,680
2013 : FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-06-30	$0
Total plan liabilities at end of year	2013-06-30	$0
Total plan liabilities at beginning of year	2013-06-30	$0
Total income from all sources	2013-06-30	$38,130
Expenses. Total of all expenses incurred	2013-06-30	$1,486
Benefits paid (including direct rollovers)	2013-06-30	$0
Total plan assets at end of year	2013-06-30	$296,583
Total plan assets at beginning of year	2013-06-30	$259,939
Total contributions received or receivable from participants	2013-06-30	$0
Expenses. Other expenses not covered elsewhere	2013-06-30	$0
Contributions received from other sources (not participants or employers)	2013-06-30	$0
Other income received	2013-06-30	$38,130
Noncash contributions received	2013-06-30	$0
Net income (gross income less expenses)	2013-06-30	$36,644
Net plan assets at end of year (total assets less liabilities)	2013-06-30	$296,583
Net plan assets at beginning of year (total assets less liabilities)	2013-06-30	$259,939
Total contributions received or receivable from employer(s)	2013-06-30	$0
Value of certain deemed distributions of participant loans	2013-06-30	$0
Value of corrective distributions	2013-06-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-06-30	$1,486
2012 : FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-06-30	$0
Total plan liabilities at end of year	2012-06-30	$0
Total plan liabilities at beginning of year	2012-06-30	$0
Total income from all sources	2012-06-30	$-8,635
Expenses. Total of all expenses incurred	2012-06-30	$1,363
Benefits paid (including direct rollovers)	2012-06-30	$0
Total plan assets at end of year	2012-06-30	$259,939
Total plan assets at beginning of year	2012-06-30	$269,937
Total contributions received or receivable from participants	2012-06-30	$0
Expenses. Other expenses not covered elsewhere	2012-06-30	$0
Contributions received from other sources (not participants or employers)	2012-06-30	$0
Other income received	2012-06-30	$-8,635
Noncash contributions received	2012-06-30	$0
Net income (gross income less expenses)	2012-06-30	$-9,998
Net plan assets at end of year (total assets less liabilities)	2012-06-30	$259,939
Net plan assets at beginning of year (total assets less liabilities)	2012-06-30	$269,937
Total contributions received or receivable from employer(s)	2012-06-30	$0
Value of certain deemed distributions of participant loans	2012-06-30	$0
Value of corrective distributions	2012-06-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-06-30	$1,363
2011 : FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-06-30	$0
Total plan liabilities at beginning of year	2011-06-30	$0
Total income from all sources	2011-06-30	$63,495
Expenses. Total of all expenses incurred	2011-06-30	$33,239
Benefits paid (including direct rollovers)	2011-06-30	$31,779
Total plan assets at end of year	2011-06-30	$269,937
Total plan assets at beginning of year	2011-06-30	$239,681
Total contributions received or receivable from participants	2011-06-30	$0
Expenses. Other expenses not covered elsewhere	2011-06-30	$0
Contributions received from other sources (not participants or employers)	2011-06-30	$0
Other income received	2011-06-30	$63,495
Noncash contributions received	2011-06-30	$0
Net income (gross income less expenses)	2011-06-30	$30,256
Net plan assets at end of year (total assets less liabilities)	2011-06-30	$269,937
Net plan assets at beginning of year (total assets less liabilities)	2011-06-30	$239,681
Total contributions received or receivable from employer(s)	2011-06-30	$0
Value of certain deemed distributions of participant loans	2011-06-30	$0
Value of corrective distributions	2011-06-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-06-30	$1,460
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-06-30	$0

Form 5500 Responses for FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN

2015: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	Yes
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2014: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2013: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2012: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2009: FOOTHILL VILLAGE SPORTS DEN, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

92905

Policy instance

Insurance contract or identification number	92905
Number of Individuals Covered	0
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,252
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,252
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS INSURANCE

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

92905

Policy instance

Insurance contract or identification number	92905
Number of Individuals Covered	6
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,415
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,415
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS INSURANCE

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

92905

Policy instance

Insurance contract or identification number	92905
Number of Individuals Covered	8
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $1,208
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,208
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISOR NETWORKS INSURANCE

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

92905

Policy instance

Insurance contract or identification number	92905
Number of Individuals Covered	8
Insurance policy start date	2012-07-23
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,133
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,133
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	FINANCIAL NETWORK INSURANCE SERVICE

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

92905

Policy instance

Insurance contract or identification number	92905
Number of Individuals Covered	8
Insurance policy start date	2011-07-23
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,107
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 number

92905

Policy instance

Insurance contract or identification number	92905
Number of Individuals Covered	8
Insurance policy start date	2010-07-23
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $509
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FOOTHILL VILLAGE SPORTS DEN, INC.
Employer identification number (EIN):	870295668
NAIC Classification:	451110
NAIC Description:	Sporting Goods Stores