401k Plan data: J. M. HALEY CORP. RETIREMENT PLAN plan

J. M. HALEY CORP. RETIREMENT PLAN 401k Plan overview

Plan Name	J. M. HALEY CORP. RETIREMENT PLAN
Plan identification number	001

J. M. HALEY CORP. RETIREMENT 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.

401k Sponsoring company profile

J. M. HALEY CORP. has sponsored the creation of one or more 401k plans.

Company Name: J. M. HALEY CORP.

Employer identification number (EIN): 112270289

NAIC Classification: 332900

Additional information about J. M. HALEY CORP.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1972-03-23

Company Identification Number: 326204

Legal Registered Office Address: 151 Toledo Street
Suffolk
Farmingdale
United States of America (USA)
11735

More information about J. M. HALEY CORP.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan J. M. HALEY CORP. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 JAMES ACKERSON
001 2016-01-01 JAMES ACKERSON 2017-10-06
001 2015-01-01 JAMES ACKERSON 2016-10-12
001 2014-01-01 JAMES ACKERSON 2015-10-05
001 2013-01-01 JAMES ACKERSON 2014-10-09
001 2012-01-01 JERRY IAVARONE 2013-09-30
001 2011-01-01 JOHN ACKERSON 2012-10-09
001 2010-01-01 JOHN ACKERSON 2011-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	JAMES ACKERSON
001	2016-01-01	JAMES ACKERSON	2017-10-06
001	2015-01-01	JAMES ACKERSON	2016-10-12
001	2014-01-01	JAMES ACKERSON	2015-10-05
001	2013-01-01	JAMES ACKERSON	2014-10-09
001	2012-01-01	JERRY IAVARONE	2013-09-30
001	2011-01-01	JOHN ACKERSON	2012-10-09
001	2010-01-01	JOHN ACKERSON	2011-10-13

Plan Statistics for J. M. HALEY CORP. RETIREMENT PLAN

401k plan membership statisitcs for J. M. HALEY CORP. RETIREMENT PLAN

Measure Date Value
2022: J. M. HALEY CORP. RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 89
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 22
Total of all active and inactive participants 2022-01-01 112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 112
Number of participants with account balances 2022-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: J. M. HALEY CORP. RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 83
Number of retired or separated participants receiving benefits 2021-01-01 3
Number of other retired or separated participants entitled to future benefits 2021-01-01 20
Total of all active and inactive participants 2021-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 106
Number of participants with account balances 2021-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 4
2020: J. M. HALEY CORP. RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 88
Number of retired or separated participants receiving benefits 2020-01-01 26
Number of other retired or separated participants entitled to future benefits 2020-01-01 2
Total of all active and inactive participants 2020-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 116
Number of participants with account balances 2020-01-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 2
2019: J. M. HALEY CORP. RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 93
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 23
Total of all active and inactive participants 2019-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 116
Number of participants with account balances 2019-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 4
2018: J. M. HALEY CORP. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 92
Number of retired or separated participants receiving benefits 2018-01-01 12
Number of other retired or separated participants entitled to future benefits 2018-01-01 7
Total of all active and inactive participants 2018-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 111
Number of participants with account balances 2018-01-01 75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 1
2017: J. M. HALEY CORP. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 103
Number of retired or separated participants receiving benefits 2017-01-01 13
Number of other retired or separated participants entitled to future benefits 2017-01-01 1
Total of all active and inactive participants 2017-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 117
Number of participants with account balances 2017-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2

Measure	Date	Value
2022: J. M. HALEY CORP. RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	89
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	22
Total of all active and inactive participants	2022-01-01	112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	112
Number of participants with account balances	2022-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: J. M. HALEY CORP. RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	83
Number of retired or separated participants receiving benefits	2021-01-01	3
Number of other retired or separated participants entitled to future benefits	2021-01-01	20
Total of all active and inactive participants	2021-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	106
Number of participants with account balances	2021-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	4
2020: J. M. HALEY CORP. RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	88
Number of retired or separated participants receiving benefits	2020-01-01	26
Number of other retired or separated participants entitled to future benefits	2020-01-01	2
Total of all active and inactive participants	2020-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	116
Number of participants with account balances	2020-01-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	2
2019: J. M. HALEY CORP. RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	93
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	23
Total of all active and inactive participants	2019-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	116
Number of participants with account balances	2019-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	4
2018: J. M. HALEY CORP. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	92
Number of retired or separated participants receiving benefits	2018-01-01	12
Number of other retired or separated participants entitled to future benefits	2018-01-01	7
Total of all active and inactive participants	2018-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	111
Number of participants with account balances	2018-01-01	75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	1
2017: J. M. HALEY CORP. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	103
Number of retired or separated participants receiving benefits	2017-01-01	13
Number of other retired or separated participants entitled to future benefits	2017-01-01	1
Total of all active and inactive participants	2017-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	117
Number of participants with account balances	2017-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2

Financial Data on J. M. HALEY CORP. RETIREMENT PLAN

Measure	Date	Value
2022 : J. M. HALEY CORP. RETIREMENT 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	$-374,525
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$537,335
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$511,312
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$548,805
Value of total assets at end of year	2022-12-31	$6,340,750
Value of total assets at beginning of year	2022-12-31	$7,252,610
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$26,023
Total interest from all sources	2022-12-31	$4,021
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$205,045
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$205,045
Administrative expenses professional fees incurred	2022-12-31	$26,023
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	$317,548
Participant contributions at end of year	2022-12-31	$117,793
Participant contributions at beginning of year	2022-12-31	$89,370
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$5,854
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$1,028,693
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$1,078,844
Other income not declared elsewhere	2022-12-31	$8,853
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	$-911,860
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$6,340,750
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$7,252,610
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	$5,050,481
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$5,962,531
Value of interest in pooled separate accounts at end of year	2022-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$0
Interest on participant loans	2022-12-31	$4,021
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,141,249
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	No
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	$231,257
Employer contributions (assets) at end of year	2022-12-31	$143,783
Employer contributions (assets) at beginning of year	2022-12-31	$116,011
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$511,312
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	TMI CPA, P.C.
Accountancy firm EIN	2022-12-31	472426908
2021 : J. M. HALEY CORP. RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
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	$1,209,473
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$297,763
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$245,432
Expenses. Certain deemed distributions of participant loans	2021-12-31	$26,262
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$522,976
Value of total assets at end of year	2021-12-31	$7,252,610
Value of total assets at beginning of year	2021-12-31	$6,340,900
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$26,069
Total interest from all sources	2021-12-31	$7,544
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$311,344
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$311,344
Administrative expenses professional fees incurred	2021-12-31	$24,299
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
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	$320,029
Participant contributions at end of year	2021-12-31	$89,370
Participant contributions at beginning of year	2021-12-31	$130,525
Participant contributions at end of year	2021-12-31	$5,854
Participant contributions at beginning of year	2021-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$1,078,844
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$982,705
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$5,894
Other income not declared elsewhere	2021-12-31	$9,805
Administrative expenses (other) incurred	2021-12-31	$1,770
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	$911,710
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$7,252,610
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$6,340,900
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	$5,962,531
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$5,132,626
Value of interest in pooled separate accounts at end of year	2021-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$0
Interest on participant loans	2021-12-31	$6,739
Interest earned on other investments	2021-12-31	$805
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$357,804
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	No
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	$197,053
Employer contributions (assets) at end of year	2021-12-31	$116,011
Employer contributions (assets) at beginning of year	2021-12-31	$95,044
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$245,432
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	TMI CPA, P.C.
Accountancy firm EIN	2021-12-31	472426908
2020 : J. M. HALEY CORP. RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,215,917
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$233,925
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$222,196
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$449,332
Value of total assets at end of year	2020-12-31	$6,340,900
Value of total assets at beginning of year	2020-12-31	$5,358,908
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$11,729
Total interest from all sources	2020-12-31	$10,645
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$158,826
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$158,826
Administrative expenses professional fees incurred	2020-12-31	$8,970
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$287,672
Participant contributions at end of year	2020-12-31	$130,525
Participant contributions at beginning of year	2020-12-31	$137,918
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$982,705
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$92,373
Other income not declared elsewhere	2020-12-31	$3,522
Administrative expenses (other) incurred	2020-12-31	$2,759
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$981,992
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$6,340,900
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,358,908
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$5,132,626
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$4,307,337
Value of interest in pooled separate accounts at end of year	2020-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$740,652
Interest on participant loans	2020-12-31	$6,863
Interest earned on other investments	2020-12-31	$3,782
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$593,592
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$161,660
Employer contributions (assets) at end of year	2020-12-31	$95,044
Employer contributions (assets) at beginning of year	2020-12-31	$80,628
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$222,196
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	TMI CPA, P.C.
Accountancy firm EIN	2020-12-31	472426908
2019 : J. M. HALEY CORP. RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	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	$0
Total income from all sources (including contributions)	2019-12-31	$1,557,781
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$625,174
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$620,613
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$526,581
Value of total assets at end of year	2019-12-31	$5,358,908
Value of total assets at beginning of year	2019-12-31	$4,426,301
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$4,561
Total interest from all sources	2019-12-31	$9,653
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$164,173
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$164,173
Was this plan covered by a fidelity bond	2019-12-31	Yes
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	No
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
Contributions received from participants	2019-12-31	$330,213
Participant contributions at end of year	2019-12-31	$137,918
Participant contributions at beginning of year	2019-12-31	$156,308
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$6,503
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$92,373
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$64,542
Other income not declared elsewhere	2019-12-31	$2,165
Administrative expenses (other) incurred	2019-12-31	$1,792
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	$932,607
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,358,908
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,426,301
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 leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$2,769
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$4,307,337
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$4,056,285
Value of interest in pooled separate accounts at end of year	2019-12-31	$740,652
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$64,723
Interest on participant loans	2019-12-31	$8,746
Interest earned on other investments	2019-12-31	$907
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	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$855,209
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	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	$196,368
Employer contributions (assets) at end of year	2019-12-31	$80,628
Employer contributions (assets) at beginning of year	2019-12-31	$77,940
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$620,613
Did the plan have assets held for investment	2019-12-31	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	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	No
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
Accountancy firm name	2019-12-31	TMI CPA, P.C.
Accountancy firm EIN	2019-12-31	472426908
2018 : J. M. HALEY CORP. RETIREMENT 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	$0
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	$152,366
Total loss/gain on sale of assets	2018-12-31	$146,628
Total of all expenses incurred	2018-12-31	$122,170
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$116,982
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$487,737
Value of total assets at end of year	2018-12-31	$4,426,301
Value of total assets at beginning of year	2018-12-31	$4,396,105
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$5,188
Total interest from all sources	2018-12-31	$5,567
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$82,716
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$82,716
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	$284,585
Participant contributions at end of year	2018-12-31	$156,308
Participant contributions at beginning of year	2018-12-31	$99,286
Participant contributions at end of year	2018-12-31	$6,503
Participant contributions at beginning of year	2018-12-31	$5,516
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$64,542
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$51,795
Other income not declared elsewhere	2018-12-31	$78
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	$30,196
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,426,301
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,396,105
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	$5,188
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$4,056,285
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$4,072,234
Value of interest in pooled separate accounts at end of year	2018-12-31	$64,723
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$58,497
Interest on participant loans	2018-12-31	$6,654
Interest earned on other investments	2018-12-31	$-1,102
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$15
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-570,360
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	Yes
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	$203,152
Employer contributions (assets) at end of year	2018-12-31	$77,940
Employer contributions (assets) at beginning of year	2018-12-31	$108,777
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$116,982
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	2018-12-31	No
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
Aggregate proceeds on sale of assets	2018-12-31	$146,628
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	TMI CPA, P.C.
Accountancy firm EIN	2018-12-31	472426908
2017 : J. M. HALEY CORP. RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$1,143,599
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$747,443
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$740,259
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$482,016
Value of total assets at end of year	2017-12-31	$4,396,105
Value of total assets at beginning of year	2017-12-31	$3,999,949
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$7,184
Total interest from all sources	2017-12-31	$3,209
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$48,033
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$48,033
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$293,553
Participant contributions at end of year	2017-12-31	$99,286
Participant contributions at beginning of year	2017-12-31	$83,698
Participant contributions at end of year	2017-12-31	$5,516
Participant contributions at beginning of year	2017-12-31	$4,118
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$51,795
Assets. Other investments not covered elsewhere at beginning of year	2017-12-31	$19,389
Other income not declared elsewhere	2017-12-31	$36,688
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$396,156
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$4,396,105
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,999,949
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$7,184
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$4,072,234
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$3,773,048
Value of interest in pooled separate accounts at end of year	2017-12-31	$58,497
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$0
Interest on participant loans	2017-12-31	$3,209
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$25,752
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$551,460
Net investment gain/loss from pooled separate accounts	2017-12-31	$22,193
Net investment gain or loss from common/collective trusts	2017-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$188,463
Employer contributions (assets) at end of year	2017-12-31	$108,777
Employer contributions (assets) at beginning of year	2017-12-31	$119,696
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$714,507
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	2017-12-31	Yes
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	TMI CPA, P.C.
Accountancy firm EIN	2017-12-31	472426908

Form 5500 Responses for J. M. HALEY CORP. RETIREMENT PLAN

2022: J. M. HALEY CORP. RETIREMENT 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: J. M. HALEY CORP. RETIREMENT 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: J. M. HALEY CORP. RETIREMENT 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: J. M. HALEY CORP. RETIREMENT 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: J. M. HALEY CORP. RETIREMENT 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: J. M. HALEY CORP. RETIREMENT 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

Insurance Providers Used on plan

SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 )

Policy contract number

01005845

Policy instance

Insurance contract or identification number	01005845
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	1
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

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

1268087-01

Policy instance

Insurance contract or identification number	1268087-01
Number of Individuals Covered	69
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?	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

SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 )

Policy contract number

01005845

Policy instance

Insurance contract or identification number	01005845
Number of Individuals Covered	6
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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 $0
Insurance broker organization code?	3

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

1268087-01

Policy instance

Insurance contract or identification number	1268087-01
Number of Individuals Covered	68
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?	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

SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 )

Policy contract number

01005845

Policy instance

Insurance contract or identification number	01005845
Number of Individuals Covered	8
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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 $0
Insurance broker organization code?	3

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0359740

Policy instance

Insurance contract or identification number	0359740
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $15
Total amount of fees paid to insurance company	USD $3
Are there contracts with allocated funds for individual policies?	1
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 $15
Amount paid for insurance broker fees	3
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

1268087-01

Policy instance

Insurance contract or identification number	1268087-01
Number of Individuals Covered	76
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	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

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0359740

Policy instance

Insurance contract or identification number	0359740
Number of Individuals Covered	1
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $607
Total amount of fees paid to insurance company	USD $135
Are there contracts with allocated funds for individual policies?	1
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 $607
Amount paid for insurance broker fees	135
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

517296-000

Policy instance

Insurance contract or identification number	517296-000
Number of Individuals Covered	73
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,439
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 $0
Amount paid for insurance broker fees	2439
Additional information about fees paid to insurance broker	TPA SERVICES
Insurance broker organization code?	5

SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 )

Policy contract number

01005845

Policy instance

Insurance contract or identification number	01005845
Number of Individuals Covered	8
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $56
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 $19
Insurance broker organization code?	3

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0359740

Policy instance

Insurance contract or identification number	0359740
Number of Individuals Covered	1
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $449
Total amount of fees paid to insurance company	USD $112
Are there contracts with allocated funds for individual policies?	1
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 $449
Amount paid for insurance broker fees	112
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3

SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 )

Policy contract number

01005845

Policy instance

Insurance contract or identification number	01005845
Number of Individuals Covered	8
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $0
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT
Insurance broker organization code?	3

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

517296-000

Policy instance

Insurance contract or identification number	517296-000
Number of Individuals Covered	75
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,483
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
Amount paid for insurance broker fees	2483
Additional information about fees paid to insurance broker	TPA SERVICES
Insurance broker organization code?	5

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0359740

Policy instance

Insurance contract or identification number	0359740
Number of Individuals Covered	1
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $809
Total amount of fees paid to insurance company	USD $203
Are there contracts with allocated funds for individual policies?	1
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 $809
Amount paid for insurance broker fees	203
Additional information about fees paid to insurance broker	NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	D. SAVAGE, P. ADAMO, I.SAVAGE

SECURITY MUTUAL LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 68772 )

Policy contract number

01005845

Policy instance

Insurance contract or identification number	01005845
Number of Individuals Covered	9
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8
Total amount of fees paid to insurance company	USD $8
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 $4
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT
Insurance broker organization code?	3
Insurance broker name	AMERICAN BUSINESS AND PROFESSIONAL

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

517296-000

Policy instance

Insurance contract or identification number	517296-000
Number of Individuals Covered	72
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,996
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 $0
Amount paid for insurance broker fees	4996
Additional information about fees paid to insurance broker	TPA SERVICES
Insurance broker organization code?	5
Insurance broker name	SENTINEL BENEFITS GROUP

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

84640

Policy instance

Insurance contract or identification number	84640
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,637
Total amount of fees paid to insurance company	USD $814
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 $3,938
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	SENTINEL BENEFITS GROUP, INC.

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Company Name:	J. M. HALEY CORP.
Employer identification number (EIN):	112270289
NAIC Classification:	332900

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1972-03-23
Company Identification Number:	326204
Legal Registered Office Address:	151 Toledo Street Suffolk Farmingdale United States of America (USA) 11735