401k Plan data: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN plan

CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN
Plan identification number	002

CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) 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
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

CCS CONTRACTOR EQUIPMENT & SUPPLY LLC has sponsored the creation of one or more 401k plans.

Company Name: CCS CONTRACTOR EQUIPMENT & SUPPLY LLC

Employer identification number (EIN): 862752734

NAIC Classification: 444190
NAIC Description: Other Building Material Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01 LORRI BUSS 2024-10-14
002 2022-01-01 CRAIG HELWIG 2023-10-12
002 2022-01-01 CRAIG HELWIG 2024-07-18
002 2021-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2023-01-01	LORRI BUSS	2024-10-14
002	2022-01-01	CRAIG HELWIG	2023-10-12
002	2022-01-01	CRAIG HELWIG	2024-07-18
002	2021-01-01

Plan Statistics for CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN

Measure Date Value
2023: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 255
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 298
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 14
Total of all active and inactive participants 2023-01-01 312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 312
Number of participants with account balances 2023-01-01 138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 4
2022: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 235
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 15
Total of all active and inactive participants 2022-01-01 251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 251
Number of participants with account balances 2022-01-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 4
2021: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 194
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 182
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 45
Total of all active and inactive participants 2021-01-01 227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 227
Number of participants with account balances 2021-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 1

Measure	Date	Value
2023: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	255
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	298
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	14
Total of all active and inactive participants	2023-01-01	312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	312
Number of participants with account balances	2023-01-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	4
2022: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	235
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	15
Total of all active and inactive participants	2022-01-01	251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	251
Number of participants with account balances	2022-01-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	4
2021: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	194
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	182
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	45
Total of all active and inactive participants	2021-01-01	227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	227
Number of participants with account balances	2021-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	1

Financial Data on CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2023 : CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$1,684,779
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$245,335
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$226,943
Value of total corrective distributions	2023-12-31	$18,164
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$1,164,162
Value of total assets at end of year	2023-12-31	$4,528,119
Value of total assets at beginning of year	2023-12-31	$3,088,675
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$228
Total interest from all sources	2023-12-31	$4,641
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$500,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$482,869
Participant contributions at end of year	2023-12-31	$70,797
Participant contributions at beginning of year	2023-12-31	$56,220
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$562,449
Other income not declared elsewhere	2023-12-31	$2,753
Total non interest bearing cash at end of year	2023-12-31	$3,279
Total non interest bearing cash at beginning of year	2023-12-31	$4,818
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$1,439,444
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$4,528,119
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$3,088,675
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$4,163,305
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$3,027,424
Interest on participant loans	2023-12-31	$2,871
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2023-12-31	$1,770
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$290,738
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$213
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$513,223
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$118,844
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$226,943
Contract administrator fees	2023-12-31	$228
Did the plan have assets held for investment	2023-12-31	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	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	PLANTE AND MORAN, PLLC
Accountancy firm EIN	2023-12-31	381357951
2022 : CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-83,746
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$53,886
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$48,861
Value of total corrective distributions	2022-12-31	$4,787
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$476,158
Value of total assets at end of year	2022-12-31	$3,088,675
Value of total assets at beginning of year	2022-12-31	$3,226,307
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$238
Total interest from all sources	2022-12-31	$3,690
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$396,884
Participant contributions at end of year	2022-12-31	$56,220
Participant contributions at beginning of year	2022-12-31	$71,148
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$2,976
Other income not declared elsewhere	2022-12-31	$2,246
Total non interest bearing cash at end of year	2022-12-31	$4,818
Total non interest bearing cash at beginning of year	2022-12-31	$11,767
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-137,632
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,088,675
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,226,307
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$3,027,424
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,124,865
Interest on participant loans	2022-12-31	$3,689
Interest earned on other investments	2022-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$213
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$88
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-565,840
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$76,298
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$18,439
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$48,861
Contract administrator fees	2022-12-31	$238
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	SELDEN FOX, LTD.
Accountancy firm EIN	2022-12-31	362985770
2021 : CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total transfer of assets to this plan	2021-12-31	$92,381
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$852,852
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$319,197
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$318,999
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$517,338
Value of total assets at end of year	2021-12-31	$3,226,307
Value of total assets at beginning of year	2021-12-31	$2,600,271
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$198
Total interest from all sources	2021-12-31	$4,675
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$265,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$310,435
Participant contributions at end of year	2021-12-31	$71,148
Participant contributions at beginning of year	2021-12-31	$82,888
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$107,392
Other income not declared elsewhere	2021-12-31	$1,876
Total non interest bearing cash at end of year	2021-12-31	$11,767
Total non interest bearing cash at beginning of year	2021-12-31	$8,449
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$533,655
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,226,307
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,600,271
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$3,124,865
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,399,386
Interest on participant loans	2021-12-31	$4,674
Interest earned on other investments	2021-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$88
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$359
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$328,963
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$99,511
Employer contributions (assets) at end of year	2021-12-31	$18,439
Employer contributions (assets) at beginning of year	2021-12-31	$109,189
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$318,999
Contract administrator fees	2021-12-31	$198
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	SELDEN FOX, LTD.
Accountancy firm EIN	2021-12-31	362985770

Form 5500 Responses for CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN

2023: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CCS CONTRACTOR EQUIPMENT & SUPPLY 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	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

83561

Policy instance

Insurance contract or identification number	83561
Number of Individuals Covered	137
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
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?	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

83561

Policy instance

Insurance contract or identification number	83561
Number of Individuals Covered	103
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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?	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

83561

Policy instance

Insurance contract or identification number	83561
Number of Individuals Covered	92
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	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

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Company Name:	CCS CONTRACTOR EQUIPMENT & SUPPLY LLC
Employer identification number (EIN):	862752734
NAIC Classification:	444190
NAIC Description:	Other Building Material Dealers