401k Plan data: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. plan

THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 401k Plan overview

Plan Name	THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC.
Plan identification number	004

THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

LABORATORY PARTNERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: LABORATORY PARTNERS, INC.

Employer identification number (EIN): 201723376

NAIC Classification: 621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2016-01-01
004 2015-01-01
004 2014-01-01 LEE D. VOGT
004 2013-01-01 LEE D. VOGT

Plan Statistics for THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC.

401k plan membership statisitcs for THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC.

Measure Date Value
2016: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
2015: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 89
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 89
Number of participants with account balances 2015-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 957
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 124
Total of all active and inactive participants 2014-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 125
Number of participants with account balances 2014-01-01 125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 981
Number of retired or separated participants receiving benefits 2013-01-01 4
Number of other retired or separated participants entitled to future benefits 2013-01-01 45
Total of all active and inactive participants 2013-01-01 1,030
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 1,030
Number of participants with account balances 2013-01-01 274
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2016: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
2015: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	89
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	89
Number of participants with account balances	2015-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	957
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	124
Total of all active and inactive participants	2014-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	125
Number of participants with account balances	2014-01-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	981
Number of retired or separated participants receiving benefits	2013-01-01	4
Number of other retired or separated participants entitled to future benefits	2013-01-01	45
Total of all active and inactive participants	2013-01-01	1,030
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	1,030
Number of participants with account balances	2013-01-01	274
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC.

Measure	Date	Value
2016 : THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2016 401k financial data
Total income from all sources	2016-05-27	$4,097
Expenses. Total of all expenses incurred	2016-05-27	$190,245
Benefits paid (including direct rollovers)	2016-05-27	$188,471
Total plan assets at end of year	2016-05-27	$0
Total plan assets at beginning of year	2016-05-27	$186,148
Value of fidelity bond covering the plan	2016-05-27	$300,000
Other income received	2016-05-27	$4,097
Net income (gross income less expenses)	2016-05-27	$-186,148
Net plan assets at end of year (total assets less liabilities)	2016-05-27	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-05-27	$186,148
Expenses. Administrative service providers (salaries,fees and commissions)	2016-05-27	$1,774
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-05-27	$0
2015 : THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$-4,073
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$268,741
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$248,988
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$186,148
Value of total assets at beginning of year	2015-12-31	$458,962
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$19,753
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Administrative expenses professional fees incurred	2015-12-31	$13,368
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Administrative expenses (other) incurred	2015-12-31	$5,247
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$5,148
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-272,814
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$186,148
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$458,962
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$186,148
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$453,814
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-4,073
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$248,988
Contract administrator fees	2015-12-31	$1,138
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	SCOTT SKIBBIE INCORPORATED
Accountancy firm EIN	2015-12-31	270851321
2014 : THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$373,673
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$467,691
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$446,030
Expenses. Certain deemed distributions of participant loans	2014-12-31	$1,326
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$341,767
Value of total assets at end of year	2014-12-31	$458,962
Value of total assets at beginning of year	2014-12-31	$552,980
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$20,335
Total interest from all sources	2014-12-31	$26
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$341,767
Administrative expenses (other) incurred	2014-12-31	$17,980
Total non interest bearing cash at end of year	2014-12-31	$5,148
Total non interest bearing cash at beginning of year	2014-12-31	$292
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-94,018
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$458,962
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$552,980
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$453,814
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$552,688
Interest on participant loans	2014-12-31	$26
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$31,880
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$446,030
Contract administrator fees	2014-12-31	$2,355
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	SCOTT SKIBBIE INCORPORATED
Accountancy firm EIN	2014-12-31	270851321
2013 : THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2013 401k financial data
Transfers to/from the plan	2013-12-31	$167,805
Total income from all sources	2013-12-31	$396,232
Expenses. Total of all expenses incurred	2013-12-31	$11,058
Benefits paid (including direct rollovers)	2013-12-31	$6,306
Total plan assets at end of year	2013-12-31	$552,979
Total plan assets at beginning of year	2013-12-31	$0
Value of fidelity bond covering the plan	2013-12-31	$300,000
Total contributions received or receivable from participants	2013-12-31	$366,433
Expenses. Other expenses not covered elsewhere	2013-12-31	$249
Other income received	2013-12-31	$29,799
Net income (gross income less expenses)	2013-12-31	$385,174
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$552,979
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$4,503
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0

Form 5500 Responses for THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC.

2016: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: THE PLATINUM 401(K) RETIREMENT SAVINGS PLAN LABORATORY PARTNERS, INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple employer plan
2013-01-01	First time form 5500 has been submitted	Yes
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

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

106614

Policy instance

Insurance contract or identification number	106614
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2016-05-27
Total amount of commissions paid to insurance broker	USD $267
Total amount of fees paid to insurance company	USD $1,605
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38
Amount paid for insurance broker fees	1556
Additional information about fees paid to insurance broker	SALES/ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	SCOTT SKIBBIE CPA

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

Policy contract number

106614

Policy instance

Insurance contract or identification number	106614
Number of Individuals Covered	192
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $886
Total amount of fees paid to insurance company	USD $14,555
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $127
Amount paid for insurance broker fees	13890
Additional information about fees paid to insurance broker	SALES/ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	INDEPENDENT FINANCIAL PARTNERS

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

Policy contract number

106614

Policy instance

Insurance contract or identification number	106614
Number of Individuals Covered	226
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,381
Total amount of fees paid to insurance company	USD $18,730
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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 $2,198
Amount paid for insurance broker fees	18253
Additional information about fees paid to insurance broker	SALES/ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	INDEPENDENT FINANCIAL PARTNERS

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

Policy contract number

106614

Policy instance

Insurance contract or identification number	106614
Number of Individuals Covered	370
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,248
Total amount of fees paid to insurance company	USD $4,800
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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 $2,159
Amount paid for insurance broker fees	4653
Additional information about fees paid to insurance broker	SALES/ADMINISTRATION
Insurance broker organization code?	5
Insurance broker name	FINANCIAL TELESIS, INC

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Company Name:	LABORATORY PARTNERS, INC.
Employer identification number (EIN):	201723376
NAIC Classification:	621510
NAIC Description:	Medical and Diagnostic Laboratories