401k Plan data: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN plan

DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 401k Plan overview

Plan Name	DAVID RIO COFFEE & TEA, INC. 401(K) PLAN
Plan identification number	001

DAVID RIO COFFEE & TEA, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

DAVID RIO COFFEE & TEA, INC. has sponsored the creation of one or more 401k plans.

Company Name: DAVID RIO COFFEE & TEA, INC.

Employer identification number (EIN): 943269338

NAIC Classification: 424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVID RIO COFFEE & TEA, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 ERISA FIDUCIARY SERVICES 2024-05-06
001 2022-01-01 ERISA FIDUCIARY SERVICES 2023-04-08
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 SCOTT LOWE SCOTT LOWE 2018-10-03
001 2016-01-01 SCOTT LOWE
001 2015-01-01 SCOTT LOWE
001 2014-01-01 SCOTT LOWE
001 2013-01-01 SCOTT LOWE
001 2012-01-01 SCOTT LOWE
001 2011-01-01 SCOTT LOWE
001 2010-01-01 SCOTT LOWE
001 2009-01-01 SCOTT LOWE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01	ERISA FIDUCIARY SERVICES	2024-05-06
001	2022-01-01	ERISA FIDUCIARY SERVICES	2023-04-08
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	SCOTT LOWE		SCOTT LOWE	2018-10-03
001	2016-01-01	SCOTT LOWE
001	2015-01-01	SCOTT LOWE
001	2014-01-01	SCOTT LOWE
001	2013-01-01	SCOTT LOWE
001	2012-01-01	SCOTT LOWE
001	2011-01-01	SCOTT LOWE
001	2010-01-01	SCOTT LOWE
001	2009-01-01	SCOTT LOWE

Plan Statistics for DAVID RIO COFFEE & TEA, INC. 401(K) PLAN

401k plan membership statisitcs for DAVID RIO COFFEE & TEA, INC. 401(K) PLAN

Measure Date Value
2021: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 10
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 8
Total of all active and inactive participants 2021-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 18
Number of participants with account balances 2021-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 1
2020: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 9
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 10
Total of all active and inactive participants 2020-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 19
Number of participants with account balances 2020-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 2
2019: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 10
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 8
Total of all active and inactive participants 2019-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 18
Number of participants with account balances 2019-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 10
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 9
Total of all active and inactive participants 2018-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 19
Number of participants with account balances 2018-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 11
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 7
Total of all active and inactive participants 2017-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 18
Number of participants with account balances 2017-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 11
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 6
Total of all active and inactive participants 2016-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 17
Number of participants with account balances 2016-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 12
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 3
Total of all active and inactive participants 2015-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 15
Number of participants with account balances 2015-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 12
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 3
Total of all active and inactive participants 2014-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 15
Number of participants with account balances 2014-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 10
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 3
Total of all active and inactive participants 2013-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 13
Number of participants with account balances 2013-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 9
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 2
Total of all active and inactive participants 2012-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 11
Number of participants with account balances 2012-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 8
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 5
Total of all active and inactive participants 2011-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 13
Number of participants with account balances 2011-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 7
Total of all active and inactive participants 2010-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 14
Number of participants with account balances 2010-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
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 7
Total of all active and inactive participants 2009-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 14
Number of participants with account balances 2009-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2021: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	10
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	8
Total of all active and inactive participants	2021-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	18
Number of participants with account balances	2021-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	1
2020: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	9
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	10
Total of all active and inactive participants	2020-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	19
Number of participants with account balances	2020-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	2
2019: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	10
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	8
Total of all active and inactive participants	2019-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	18
Number of participants with account balances	2019-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	10
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	9
Total of all active and inactive participants	2018-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	19
Number of participants with account balances	2018-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	11
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	7
Total of all active and inactive participants	2017-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	18
Number of participants with account balances	2017-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	11
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	6
Total of all active and inactive participants	2016-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	17
Number of participants with account balances	2016-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	12
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	3
Total of all active and inactive participants	2015-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	15
Number of participants with account balances	2015-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	12
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	3
Total of all active and inactive participants	2014-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	15
Number of participants with account balances	2014-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	10
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	3
Total of all active and inactive participants	2013-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	13
Number of participants with account balances	2013-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	9
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	2
Total of all active and inactive participants	2012-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	11
Number of participants with account balances	2012-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	8
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	5
Total of all active and inactive participants	2011-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	13
Number of participants with account balances	2011-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	7
Total of all active and inactive participants	2010-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	14
Number of participants with account balances	2010-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
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	7
Total of all active and inactive participants	2009-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	14
Number of participants with account balances	2009-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on DAVID RIO COFFEE & TEA, INC. 401(K) PLAN

Measure	Date	Value
2021 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$426,395
Expenses. Total of all expenses incurred	2021-12-31	$18,397
Benefits paid (including direct rollovers)	2021-12-31	$1,292
Total plan assets at end of year	2021-12-31	$2,126,179
Total plan assets at beginning of year	2021-12-31	$1,718,181
Value of fidelity bond covering the plan	2021-12-31	$200,000
Total contributions received or receivable from participants	2021-12-31	$56,739
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$214,560
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$407,998
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$2,126,179
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,718,181
Assets. Value of participant loans	2021-12-31	$92,363
Total contributions received or receivable from employer(s)	2021-12-31	$155,096
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$17,105
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$246,406
Expenses. Total of all expenses incurred	2020-12-31	$19,583
Benefits paid (including direct rollovers)	2020-12-31	$6,278
Total plan assets at end of year	2020-12-31	$1,718,181
Total plan assets at beginning of year	2020-12-31	$1,491,358
Value of fidelity bond covering the plan	2020-12-31	$200,000
Total contributions received or receivable from participants	2020-12-31	$33,095
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$196,846
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$226,823
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,718,181
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$1,491,358
Assets. Value of participant loans	2020-12-31	$5,609
Total contributions received or receivable from employer(s)	2020-12-31	$16,465
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$13,305
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$366,480
Expenses. Total of all expenses incurred	2019-12-31	$128,848
Benefits paid (including direct rollovers)	2019-12-31	$116,323
Total plan assets at end of year	2019-12-31	$1,491,358
Total plan assets at beginning of year	2019-12-31	$1,253,726
Value of fidelity bond covering the plan	2019-12-31	$150,000
Total contributions received or receivable from participants	2019-12-31	$55,945
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$261,845
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$237,632
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,491,358
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,253,726
Assets. Value of participant loans	2019-12-31	$18,083
Total contributions received or receivable from employer(s)	2019-12-31	$48,690
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$12,525
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$30,475
Expenses. Total of all expenses incurred	2018-12-31	$27,237
Benefits paid (including direct rollovers)	2018-12-31	$16,081
Total plan assets at end of year	2018-12-31	$1,253,726
Total plan assets at beginning of year	2018-12-31	$1,250,488
Value of fidelity bond covering the plan	2018-12-31	$150,000
Total contributions received or receivable from participants	2018-12-31	$64,276
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-82,462
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$3,238
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$1,253,726
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,250,488
Assets. Value of participant loans	2018-12-31	$49,062
Total contributions received or receivable from employer(s)	2018-12-31	$48,661
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$11,156
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$263,084
Expenses. Total of all expenses incurred	2017-12-31	$11,023
Benefits paid (including direct rollovers)	2017-12-31	$6,000
Total plan assets at end of year	2017-12-31	$1,250,488
Total plan assets at beginning of year	2017-12-31	$998,427
Value of fidelity bond covering the plan	2017-12-31	$150,000
Total contributions received or receivable from participants	2017-12-31	$54,019
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$137,098
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$252,061
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,250,488
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$998,427
Assets. Value of participant loans	2017-12-31	$77,162
Total contributions received or receivable from employer(s)	2017-12-31	$71,967
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$5,023
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$192,274
Expenses. Total of all expenses incurred	2016-12-31	$450
Benefits paid (including direct rollovers)	2016-12-31	$260
Total plan assets at end of year	2016-12-31	$998,427
Total plan assets at beginning of year	2016-12-31	$806,603
Value of fidelity bond covering the plan	2016-12-31	$100,000
Total contributions received or receivable from participants	2016-12-31	$60,858
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$88,002
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$191,824
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$998,427
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$806,603
Assets. Value of participant loans	2016-12-31	$73,680
Total contributions received or receivable from employer(s)	2016-12-31	$43,414
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$190
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$117,716
Expenses. Total of all expenses incurred	2015-12-31	$397
Benefits paid (including direct rollovers)	2015-12-31	$222
Total plan assets at end of year	2015-12-31	$806,603
Total plan assets at beginning of year	2015-12-31	$689,284
Value of fidelity bond covering the plan	2015-12-31	$85,000
Total contributions received or receivable from participants	2015-12-31	$75,500
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$4,368
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$117,319
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$806,603
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$689,284
Assets. Value of participant loans	2015-12-31	$57,936
Total contributions received or receivable from employer(s)	2015-12-31	$37,848
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	$175
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$129,057
Expenses. Total of all expenses incurred	2014-12-31	$14,617
Benefits paid (including direct rollovers)	2014-12-31	$14,517
Total plan assets at end of year	2014-12-31	$689,284
Total plan assets at beginning of year	2014-12-31	$574,844
Value of fidelity bond covering the plan	2014-12-31	$70,000
Total contributions received or receivable from participants	2014-12-31	$51,936
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$40,744
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$114,440
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$689,284
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$574,844
Assets. Value of participant loans	2014-12-31	$49,146
Total contributions received or receivable from employer(s)	2014-12-31	$36,377
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$100
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$179,621
Expenses. Total of all expenses incurred	2013-12-31	$3
Benefits paid (including direct rollovers)	2013-12-31	$3
Total plan assets at end of year	2013-12-31	$574,844
Total plan assets at beginning of year	2013-12-31	$395,226
Value of fidelity bond covering the plan	2013-12-31	$60,000
Total contributions received or receivable from participants	2013-12-31	$56,918
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$97,152
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$179,618
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$574,844
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$395,226
Assets. Value of participant loans	2013-12-31	$71,584
Total contributions received or receivable from employer(s)	2013-12-31	$25,551
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : DAVID RIO COFFEE & TEA, INC. 401(K) 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	$115,079
Expenses. Total of all expenses incurred	2012-12-31	$23,145
Benefits paid (including direct rollovers)	2012-12-31	$23,145
Total plan assets at end of year	2012-12-31	$395,226
Total plan assets at beginning of year	2012-12-31	$303,292
Value of fidelity bond covering the plan	2012-12-31	$40,000
Total contributions received or receivable from participants	2012-12-31	$47,747
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$32,362
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$91,934
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$395,226
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$303,292
Assets. Value of participant loans	2012-12-31	$58,216
Total contributions received or receivable from employer(s)	2012-12-31	$34,970
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : DAVID RIO COFFEE & TEA, INC. 401(K) 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	$58,712
Expenses. Total of all expenses incurred	2011-12-31	$1,183
Benefits paid (including direct rollovers)	2011-12-31	$1,183
Total plan assets at end of year	2011-12-31	$303,292
Total plan assets at beginning of year	2011-12-31	$245,763
Value of fidelity bond covering the plan	2011-12-31	$35,000
Total contributions received or receivable from participants	2011-12-31	$40,823
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-251
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$57,529
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$303,292
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$245,763
Assets. Value of participant loans	2011-12-31	$74,487
Total contributions received or receivable from employer(s)	2011-12-31	$18,140
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : DAVID RIO COFFEE & TEA, INC. 401(K) 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	$69,968
Expenses. Total of all expenses incurred	2010-12-31	$26,658
Benefits paid (including direct rollovers)	2010-12-31	$26,658
Total plan assets at end of year	2010-12-31	$245,763
Total plan assets at beginning of year	2010-12-31	$202,453
Value of fidelity bond covering the plan	2010-12-31	$25,000
Total contributions received or receivable from participants	2010-12-31	$20,257
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$24,106
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$43,310
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$245,763
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$202,453
Assets. Value of participant loans	2010-12-31	$28,768
Total contributions received or receivable from employer(s)	2010-12-31	$25,605
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0
2009 : DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for DAVID RIO COFFEE & TEA, INC. 401(K) PLAN

2021: DAVID RIO COFFEE & TEA, INC. 401(K) 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
2020: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: DAVID RIO COFFEE & TEA, INC. 401(K) 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	No
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: DAVID RIO COFFEE & TEA, INC. 401(K) 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: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: DAVID RIO COFFEE & TEA, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: DAVID RIO COFFEE & TEA, INC. 401(K) 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 – Trust	Yes
2009-01-01	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

130053

Policy instance

Insurance contract or identification number	130053
Number of Individuals Covered	17
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,563
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $3,563
Insurance broker organization code?	3

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

Policy contract number

130053

Policy instance

Insurance contract or identification number	130053
Number of Individuals Covered	15
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,675
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $5,675
Insurance broker organization code?	3

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

Policy contract number

130053

Policy instance

Insurance contract or identification number	130053
Number of Individuals Covered	16
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,279
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $5,279
Insurance broker organization code?	3

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

Policy contract number

130053

Policy instance

Insurance contract or identification number	130053
Number of Individuals Covered	17
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,775
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $4,775
Insurance broker organization code?	3

Potentially related plans

DAVID RIOS SALON AND SPA 401(K) PLAN [EIN = 455159419]

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Company Name:	DAVID RIO COFFEE & TEA, INC.
Employer identification number (EIN):	943269338
NAIC Classification:	424400