401k Plan data: HERITAGE BANK 401K PLAN plan

HERITAGE BANK 401K PLAN 401k Plan overview

Plan Name	HERITAGE BANK 401K PLAN
Plan identification number	002

HERITAGE BANK 401K PLAN Benefits

401k Plan Type

Defined 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

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

Company Name: HERITAGE SOUTHEAST BANK

Employer identification number (EIN): 580659995

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2019-01-01
002 2018-01-01
002 2017-01-01 SHIRLEY ETHERIDGE
002 2016-01-01 MARY JO JESTER
002 2015-01-01
002 2014-01-01 DAVID TURNER
002 2013-01-01 DAVID TURNER
002 2012-01-01 DAVID TURNER
002 2011-01-01 DAVID TURNER
002 2009-01-01 DAVID TURNER DAVID TURNER 2010-07-09

Plan Statistics for HERITAGE BANK 401K PLAN

401k plan membership statisitcs for HERITAGE BANK 401K PLAN

Measure Date Value
2019: HERITAGE BANK 401K PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: HERITAGE BANK 401K PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 120
Number of retired or separated participants receiving benefits 2018-01-01 8
Number of other retired or separated participants entitled to future benefits 2018-01-01 15
Total of all active and inactive participants 2018-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 143
Number of participants with account balances 2018-01-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 7
2017: HERITAGE BANK 401K PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 95
Number of retired or separated participants receiving benefits 2017-01-01 7
Number of other retired or separated participants entitled to future benefits 2017-01-01 18
Total of all active and inactive participants 2017-01-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 120
Number of participants with account balances 2017-01-01 104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 3
2016: HERITAGE BANK 401K PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 91
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 18
Total of all active and inactive participants 2016-01-01 109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 109
Number of participants with account balances 2016-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: HERITAGE BANK 401K PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 90
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 29
Total of all active and inactive participants 2015-01-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 119
Number of participants with account balances 2015-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 4
2014: HERITAGE BANK 401K PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 84
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 33
Total of all active and inactive participants 2014-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 117
Number of participants with account balances 2014-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: HERITAGE BANK 401K PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 83
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 86
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 30
Total of all active and inactive participants 2013-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 116
Number of participants with account balances 2013-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: HERITAGE BANK 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 69
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 14
Total of all active and inactive participants 2012-01-01 83
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 83
Number of participants with account balances 2012-01-01 63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: HERITAGE BANK 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 76
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 13
Total of all active and inactive participants 2011-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 89
Number of participants with account balances 2011-01-01 69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2009: HERITAGE BANK 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 84
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 10
Total of all active and inactive participants 2009-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 94
Number of participants with account balances 2009-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 9

Measure	Date	Value
2019: HERITAGE BANK 401K PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: HERITAGE BANK 401K PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	120
Number of retired or separated participants receiving benefits	2018-01-01	8
Number of other retired or separated participants entitled to future benefits	2018-01-01	15
Total of all active and inactive participants	2018-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	143
Number of participants with account balances	2018-01-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	7
2017: HERITAGE BANK 401K PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	95
Number of retired or separated participants receiving benefits	2017-01-01	7
Number of other retired or separated participants entitled to future benefits	2017-01-01	18
Total of all active and inactive participants	2017-01-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	120
Number of participants with account balances	2017-01-01	104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	3
2016: HERITAGE BANK 401K PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	91
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	18
Total of all active and inactive participants	2016-01-01	109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	109
Number of participants with account balances	2016-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: HERITAGE BANK 401K PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	90
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	29
Total of all active and inactive participants	2015-01-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	119
Number of participants with account balances	2015-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	4
2014: HERITAGE BANK 401K PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	84
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	33
Total of all active and inactive participants	2014-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	117
Number of participants with account balances	2014-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: HERITAGE BANK 401K PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	83
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	86
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	30
Total of all active and inactive participants	2013-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	116
Number of participants with account balances	2013-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: HERITAGE BANK 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	69
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	14
Total of all active and inactive participants	2012-01-01	83
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	83
Number of participants with account balances	2012-01-01	63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: HERITAGE BANK 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	76
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	13
Total of all active and inactive participants	2011-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	89
Number of participants with account balances	2011-01-01	69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2009: HERITAGE BANK 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	84
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	10
Total of all active and inactive participants	2009-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	94
Number of participants with account balances	2009-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	9

Financial Data on HERITAGE BANK 401K PLAN

Measure	Date	Value
2019 : HERITAGE BANK 401K PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets from this plan	2019-12-31	$6,446,770
Total transfer of assets from this plan	2019-12-31	$6,446,770
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$87
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$87
Total income from all sources (including contributions)	2019-12-31	$1,757,481
Total income from all sources (including contributions)	2019-12-31	$1,757,481
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$351,290
Total of all expenses incurred	2019-12-31	$351,290
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$326,862
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$326,862
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$664,540
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$664,540
Value of total assets at end of year	2019-12-31	$0
Value of total assets at end of year	2019-12-31	$0
Value of total assets at beginning of year	2019-12-31	$5,040,666
Value of total assets at beginning of year	2019-12-31	$5,040,666
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$24,428
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$24,428
Total interest from all sources	2019-12-31	$2,947
Total interest from all sources	2019-12-31	$2,947
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$-28,283
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$-28,283
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$-28,283
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$-28,283
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$371,931
Contributions received from participants	2019-12-31	$371,931
Participant contributions at end of year	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$63,172
Participant contributions at beginning of year	2019-12-31	$63,172
Participant contributions at end of year	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$35,743
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$35,743
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$87
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$87
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$1,406,191
Value of net income/loss	2019-12-31	$1,406,191
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$5,040,579
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$5,040,579
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$222,633
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$222,633
Value of interest in pooled separate accounts at end of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$4,749,929
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$4,749,929
Interest on participant loans	2019-12-31	$2,947
Interest on participant loans	2019-12-31	$2,947
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$4,303
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$4,303
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$4,303
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$4,303
Net investment gain/loss from pooled separate accounts	2019-12-31	$1,118,277
Net investment gain/loss from pooled separate accounts	2019-12-31	$1,118,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$256,866
Contributions received in cash from employer	2019-12-31	$256,866
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$629
Employer contributions (assets) at beginning of year	2019-12-31	$629
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$326,862
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$326,862
Contract administrator fees	2019-12-31	$24,428
Contract administrator fees	2019-12-31	$24,428
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	No
Did the plan have assets held for investment	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	Yes
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	HANCOCK ASKEW & CO LLP
Accountancy firm name	2019-12-31	HANCOCK ASKEW & CO LLP
Accountancy firm EIN	2019-12-31	580662558
Accountancy firm EIN	2019-12-31	580662558
2018 : HERITAGE BANK 401K PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$87
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$339,628
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$73,691
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$60,191
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$527,937
Value of total assets at end of year	2018-12-31	$5,040,666
Value of total assets at beginning of year	2018-12-31	$4,774,642
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$13,500
Total interest from all sources	2018-12-31	$2,588
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$408,737
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$408,737
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$308,354
Participant contributions at end of year	2018-12-31	$63,172
Participant contributions at beginning of year	2018-12-31	$55,819
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$1,290
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$87
Administrative expenses (other) incurred	2018-12-31	$674
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$265,937
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$5,040,579
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,774,642
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$12,826
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$222,633
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$231,057
Value of interest in pooled separate accounts at end of year	2018-12-31	$4,749,929
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$4,484,006
Interest on participant loans	2018-12-31	$2,588
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$4,303
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$3,131
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$5,616
Net investment gain/loss from pooled separate accounts	2018-12-31	$-605,250
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$218,293
Employer contributions (assets) at end of year	2018-12-31	$629
Employer contributions (assets) at beginning of year	2018-12-31	$629
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$60,191
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	WIPFLI LLP
Accountancy firm EIN	2018-12-31	390758449
2017 : HERITAGE BANK 401K PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$1,108,314
Expenses. Total of all expenses incurred	2017-12-31	$1,037,174
Benefits paid (including direct rollovers)	2017-12-31	$1,023,735
Total plan assets at end of year	2017-12-31	$4,774,642
Total plan assets at beginning of year	2017-12-31	$4,703,502
Value of fidelity bond covering the plan	2017-12-31	$500,000
Total contributions received or receivable from participants	2017-12-31	$222,967
Contributions received from other sources (not participants or employers)	2017-12-31	$8,363
Other income received	2017-12-31	$788,312
Net income (gross income less expenses)	2017-12-31	$71,140
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$4,774,642
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$4,703,502
Assets. Value of participant loans	2017-12-31	$55,819
Assets. Value of employer securities	2017-12-31	$220,334
Total contributions received or receivable from employer(s)	2017-12-31	$88,672
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$13,439
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : HERITAGE BANK 401K PLAN 2016 401k financial data
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$638,341
Expenses. Total of all expenses incurred	2016-12-31	$75,710
Benefits paid (including direct rollovers)	2016-12-31	$64,009
Total plan assets at end of year	2016-12-31	$4,703,502
Total plan assets at beginning of year	2016-12-31	$4,140,871
Value of fidelity bond covering the plan	2016-12-31	$500,000
Total contributions received or receivable from participants	2016-12-31	$227,414
Contributions received from other sources (not participants or employers)	2016-12-31	$17,290
Other income received	2016-12-31	$313,085
Net income (gross income less expenses)	2016-12-31	$562,631
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$4,703,502
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$4,140,871
Assets. Value of participant loans	2016-12-31	$41,090
Assets. Value of employer securities	2016-12-31	$159,157
Total contributions received or receivable from employer(s)	2016-12-31	$80,552
Value of certain deemed distributions of participant loans	2016-12-31	$390
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$11,311
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : HERITAGE BANK 401K PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$2,269
Total income from all sources	2015-12-31	$336,722
Expenses. Total of all expenses incurred	2015-12-31	$243,112
Benefits paid (including direct rollovers)	2015-12-31	$232,273
Total plan assets at end of year	2015-12-31	$4,140,871
Total plan assets at beginning of year	2015-12-31	$4,049,530
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$184,548
Contributions received from other sources (not participants or employers)	2015-12-31	$102,082
Other income received	2015-12-31	$-18,042
Net income (gross income less expenses)	2015-12-31	$93,610
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$4,140,871
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$4,047,261
Assets. Value of participant loans	2015-12-31	$66,101
Assets. Value of employer securities	2015-12-31	$83,401
Total contributions received or receivable from employer(s)	2015-12-31	$68,134
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$10,839
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : HERITAGE BANK 401K PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$2,269
Total plan liabilities at beginning of year	2014-12-31	$2,269
Total income from all sources	2014-12-31	$426,362
Expenses. Total of all expenses incurred	2014-12-31	$243,930
Benefits paid (including direct rollovers)	2014-12-31	$234,584
Total plan assets at end of year	2014-12-31	$4,049,530
Total plan assets at beginning of year	2014-12-31	$3,867,098
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$147,093
Contributions received from other sources (not participants or employers)	2014-12-31	$48,019
Other income received	2014-12-31	$194,476
Net income (gross income less expenses)	2014-12-31	$182,432
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$4,047,261
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$3,864,829
Assets. Value of participant loans	2014-12-31	$94,821
Assets. Value of employer securities	2014-12-31	$150,359
Total contributions received or receivable from employer(s)	2014-12-31	$36,774
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$9,346
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : HERITAGE BANK 401K PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$371,171
Total plan liabilities at end of year	2013-12-31	$2,269
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$855,091
Expenses. Total of all expenses incurred	2013-12-31	$60,331
Benefits paid (including direct rollovers)	2013-12-31	$51,068
Total plan assets at end of year	2013-12-31	$3,867,098
Total plan assets at beginning of year	2013-12-31	$2,698,898
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$129,571
Other income received	2013-12-31	$694,291
Net income (gross income less expenses)	2013-12-31	$794,760
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$3,864,829
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,698,898
Assets. Value of participant loans	2013-12-31	$99,786
Assets. Value of employer securities	2013-12-31	$243,708
Total contributions received or receivable from employer(s)	2013-12-31	$31,229
Value of corrective distributions	2013-12-31	$1,870
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$7,393
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : HERITAGE BANK 401K PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$487,700
Expenses. Total of all expenses incurred	2012-12-31	$305,772
Benefits paid (including direct rollovers)	2012-12-31	$299,905
Total plan assets at end of year	2012-12-31	$2,698,898
Total plan assets at beginning of year	2012-12-31	$2,516,970
Value of fidelity bond covering the plan	2012-12-31	$265,000
Total contributions received or receivable from participants	2012-12-31	$120,914
Contributions received from other sources (not participants or employers)	2012-12-31	$9,071
Other income received	2012-12-31	$345,623
Net income (gross income less expenses)	2012-12-31	$181,928
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,698,898
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,516,970
Assets. Value of participant loans	2012-12-31	$78,640
Total contributions received or receivable from employer(s)	2012-12-31	$12,092
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$5,867
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : HERITAGE BANK 401K PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$85,647
Expenses. Total of all expenses incurred	2011-12-31	$184,195
Benefits paid (including direct rollovers)	2011-12-31	$164,110
Total plan assets at end of year	2011-12-31	$2,516,970
Total plan assets at beginning of year	2011-12-31	$2,615,518
Value of fidelity bond covering the plan	2011-12-31	$265,000
Total contributions received or receivable from participants	2011-12-31	$120,007
Contributions received from other sources (not participants or employers)	2011-12-31	$17,645
Other income received	2011-12-31	$-54,802
Net income (gross income less expenses)	2011-12-31	$-98,548
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,516,970
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,615,518
Assets. Value of participant loans	2011-12-31	$604,460
Total contributions received or receivable from employer(s)	2011-12-31	$2,797
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$20,085
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : HERITAGE BANK 401K PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$452,197
Expenses. Total of all expenses incurred	2010-12-31	$61,937
Benefits paid (including direct rollovers)	2010-12-31	$35,307
Total plan assets at end of year	2010-12-31	$2,615,518
Total plan assets at beginning of year	2010-12-31	$2,225,258
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$139,201
Other income received	2010-12-31	$312,996
Net income (gross income less expenses)	2010-12-31	$390,260
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,615,518
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,225,258
Assets. Value of participant loans	2010-12-31	$59,062
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$26,630

Form 5500 Responses for HERITAGE BANK 401K PLAN

2019: HERITAGE BANK 401K PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: HERITAGE BANK 401K PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: HERITAGE BANK 401K PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: HERITAGE BANK 401K PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: HERITAGE BANK 401K PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: HERITAGE BANK 401K PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: HERITAGE BANK 401K PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: HERITAGE BANK 401K PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: HERITAGE BANK 401K PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: HERITAGE BANK 401K PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,058
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $635
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	23
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,444
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $866
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	20
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,427
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $856
Insurance broker organization code?	3
Insurance broker name	STEVEN HALE NORTHEASTERN MUTUAL INV

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	15
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,477
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $886
Insurance broker organization code?	3
Insurance broker name	STEVEN HALE NORTHEASTERN MUTUAL INV

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	11
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,353
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $812
Insurance broker organization code?	3
Insurance broker name	STEVEN HALE NORTHEASTERN MUTUAL INV

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	64
Insurance policy start date	2013-10-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,235
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $741
Insurance broker organization code?	3
Insurance broker name	STEVEN HALE NORTHEASTERN MUTUAL INV

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	63
Insurance policy start date	2012-10-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,335
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $801
Insurance broker organization code?	3
Insurance broker name	STEVEN HALE NORTHEASTERN MUTUAL INV

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

333170-01

Policy instance

Insurance contract or identification number	333170-01
Number of Individuals Covered	69
Insurance policy start date	2011-10-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,975
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 number

89237

Policy instance

Insurance contract or identification number	89237
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-10-03
Total amount of commissions paid to insurance broker	USD $11,919
Total amount of fees paid to insurance company	USD $1,460
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 number

89237

Policy instance

Insurance contract or identification number	89237
Number of Individuals Covered	83
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $13,684
Total amount of fees paid to insurance company	USD $4,442
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $13,684
Insurance broker organization code?	4
Amount paid for insurance broker fees	4442
Additional information about fees paid to insurance broker	TPA ADMINSITRATIVE FEES
Insurance broker name	SCHACHLE BENEFIT SERVICES INC

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Company Name:	HERITAGE SOUTHEAST BANK
Employer identification number (EIN):	580659995
NAIC Classification:	522110
NAIC Description:	Commercial Banking