AMERISERV FINANCIAL 401K PROFIT SHARING 401k Plan overview

Plan Name	AMERISERV FINANCIAL 401K PROFIT SHARING
Plan identification number	002

AMERISERV FINANCIAL 401K PROFIT SHARING 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. 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.

401k Sponsoring company profile

AMERISERV FINANCIAL has sponsored the creation of one or more 401k plans.

Company Name:	AMERISERV FINANCIAL
Employer identification number (EIN):	250851535
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERISERV FINANCIAL 401K PROFIT SHARING

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	MICHELE SCANLAN	2023-06-12
002	2021-01-01	MICHELE SCANLAN	2022-06-09
002	2020-01-01	MICHELE SCANLAN	2021-06-20
002	2019-01-01	EILEEN ITELL	2020-06-24
002	2018-01-01
002	2017-01-01
002	2016-01-01	EILEEN ITELL
002	2015-01-01	EILEEN ITELL
002	2014-01-01	AMY BRAZILL
002	2013-01-01	TOBIE GUNBY		TOBIE GUNBY	2014-11-13
002	2012-01-01	TOBIE GUNBY		TOBIE GUNBY	2013-07-09
002	2011-01-01	TOBIE GUNBY		TOBIE GUNBY	2012-07-18
002	2009-01-01	TOBIE GUNBY

Plan Statistics for AMERISERV FINANCIAL 401K PROFIT SHARING

401k plan membership statisitcs for AMERISERV FINANCIAL 401K PROFIT SHARING

Measure	Date	Value
2022: AMERISERV FINANCIAL 401K PROFIT SHARING 2022 401k membership
Total participants, beginning-of-year	2022-01-01	439
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	344
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	112
Total of all active and inactive participants	2022-01-01	456
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	456
Number of participants with account balances	2022-01-01	438
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	7
2021: AMERISERV FINANCIAL 401K PROFIT SHARING 2021 401k membership
Total participants, beginning-of-year	2021-01-01	524
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	335
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	104
Total of all active and inactive participants	2021-01-01	439
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	439
Number of participants with account balances	2021-01-01	425
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	8
2020: AMERISERV FINANCIAL 401K PROFIT SHARING 2020 401k membership
Total participants, beginning-of-year	2020-01-01	405
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	436
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	88
Total of all active and inactive participants	2020-01-01	524
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	524
Number of participants with account balances	2020-01-01	398
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	9
2019: AMERISERV FINANCIAL 401K PROFIT SHARING 2019 401k membership
Total participants, beginning-of-year	2019-01-01	394
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	334
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	71
Total of all active and inactive participants	2019-01-01	405
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	405
Number of participants with account balances	2019-01-01	398
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	13
2018: AMERISERV FINANCIAL 401K PROFIT SHARING 2018 401k membership
Total participants, beginning-of-year	2018-01-01	392
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	320
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	73
Total of all active and inactive participants	2018-01-01	393
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	394
Number of participants with account balances	2018-01-01	394
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	6
2017: AMERISERV FINANCIAL 401K PROFIT SHARING 2017 401k membership
Total participants, beginning-of-year	2017-01-01	403
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	321
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	70
Total of all active and inactive participants	2017-01-01	391
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	392
Number of participants with account balances	2017-01-01	392
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	20
2016: AMERISERV FINANCIAL 401K PROFIT SHARING 2016 401k membership
Total participants, beginning-of-year	2016-01-01	415
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	322
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	80
Total of all active and inactive participants	2016-01-01	402
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	403
Number of participants with account balances	2016-01-01	403
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	18
2015: AMERISERV FINANCIAL 401K PROFIT SHARING 2015 401k membership
Total participants, beginning-of-year	2015-01-01	398
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	321
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	93
Total of all active and inactive participants	2015-01-01	414
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	415
Number of participants with account balances	2015-01-01	413
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	8
2014: AMERISERV FINANCIAL 401K PROFIT SHARING 2014 401k membership
Total participants, beginning-of-year	2014-01-01	397
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	305
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	92
Total of all active and inactive participants	2014-01-01	397
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	398
Number of participants with account balances	2014-01-01	398
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	11
2013: AMERISERV FINANCIAL 401K PROFIT SHARING 2013 401k membership
Total participants, beginning-of-year	2013-01-01	374
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	371
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	25
Total of all active and inactive participants	2013-01-01	396
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	397
Number of participants with account balances	2013-01-01	397
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: AMERISERV FINANCIAL 401K PROFIT SHARING 2012 401k membership
Total participants, beginning-of-year	2012-01-01	383
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	338
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	34
Total of all active and inactive participants	2012-01-01	372
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	2
Total participants	2012-01-01	374
Number of participants with account balances	2012-01-01	374
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: AMERISERV FINANCIAL 401K PROFIT SHARING 2011 401k membership
Total participants, beginning-of-year	2011-01-01	383
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	336
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	45
Total of all active and inactive participants	2011-01-01	381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	2
Total participants	2011-01-01	383
Number of participants with account balances	2011-01-01	383
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2009: AMERISERV FINANCIAL 401K PROFIT SHARING 2009 401k membership
Total participants, beginning-of-year	2009-01-01	405
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	338
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	43
Total of all active and inactive participants	2009-01-01	381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	2
Total participants	2009-01-01	383
Number of participants with account balances	2009-01-01	383
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on AMERISERV FINANCIAL 401K PROFIT SHARING

Measure	Date	Value
2022 : AMERISERV FINANCIAL 401K PROFIT SHARING 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2022-12-31	$-1,624
Total unrealized appreciation/depreciation of assets	2022-12-31	$-1,624
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	$-3,555,458
Total loss/gain on sale of assets	2022-12-31	$6,241
Total of all expenses incurred	2022-12-31	$7,830,937
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$7,794,733
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,528,085
Value of total assets at end of year	2022-12-31	$35,990,880
Value of total assets at beginning of year	2022-12-31	$47,377,275
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$36,204
Total interest from all sources	2022-12-31	$99,693
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$158,092
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$145,040
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
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	$1,456,401
Participant contributions at end of year	2022-12-31	$498,627
Participant contributions at beginning of year	2022-12-31	$512,878
Participant contributions at end of year	2022-12-31	$56,994
Participant contributions at beginning of year	2022-12-31	$53,572
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$263,582
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$15,418
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$2,462
Administrative expenses (other) incurred	2022-12-31	$36,261
Total non interest bearing cash at end of year	2022-12-31	$20
Total non interest bearing cash at beginning of year	2022-12-31	$65
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	$-11,386,395
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$35,990,880
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$47,377,275
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
Investment advisory and management fees	2022-12-31	$-57
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$9,941,987
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$14,081,281
Interest on participant loans	2022-12-31	$14,122
Interest earned on other investments	2022-12-31	$34,076
Value of interest in common/collective trusts at end of year	2022-12-31	$21,449,686
Value of interest in common/collective trusts at beginning of year	2022-12-31	$28,521,273
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$3,239,437
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$3,409,451
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$3,409,451
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$51,495
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$327,415
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$330,362
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-2,749,414
Net investment gain or loss from common/collective trusts	2022-12-31	$-3,596,531
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
Assets. Invements in employer securities at end of year	2022-12-31	$425,445
Assets. Invements in employer securities at beginning of year	2022-12-31	$434,435
Contributions received in cash from employer	2022-12-31	$808,102
Employer contributions (assets) at end of year	2022-12-31	$35,851
Employer contributions (assets) at beginning of year	2022-12-31	$31,496
Income. Dividends from common stock	2022-12-31	$13,052
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$7,794,733
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
Aggregate proceeds on sale of assets	2022-12-31	$64,959
Aggregate carrying amount (costs) on sale of assets	2022-12-31	$58,718
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	S.R. SNODGRASS, P.C
Accountancy firm EIN	2022-12-31	251616561
2021 : AMERISERV FINANCIAL 401K PROFIT SHARING 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2021-12-31	$88,892
Total unrealized appreciation/depreciation of assets	2021-12-31	$88,892
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	$10,115,827
Total loss/gain on sale of assets	2021-12-31	$-16,098
Total of all expenses incurred	2021-12-31	$4,210,493
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$4,190,775
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,757,668
Value of total assets at end of year	2021-12-31	$47,377,275
Value of total assets at beginning of year	2021-12-31	$41,471,941
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$19,718
Total interest from all sources	2021-12-31	$33,556
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$239,411
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$209,031
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
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	$1,386,722
Participant contributions at end of year	2021-12-31	$512,878
Participant contributions at beginning of year	2021-12-31	$553,181
Participant contributions at end of year	2021-12-31	$53,572
Participant contributions at beginning of year	2021-12-31	$51,676
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$663,195
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$2,462
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$3,114
Administrative expenses (other) incurred	2021-12-31	$19,718
Total non interest bearing cash at end of year	2021-12-31	$65
Total non interest bearing cash at beginning of year	2021-12-31	$3,357
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	$5,905,334
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$47,377,275
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$41,471,941
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	$14,081,281
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$15,460,783
Interest on participant loans	2021-12-31	$18,188
Interest earned on other investments	2021-12-31	$14,817
Value of interest in common/collective trusts at end of year	2021-12-31	$28,521,273
Value of interest in common/collective trusts at beginning of year	2021-12-31	$22,010,441
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$3,409,451
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$2,103,553
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$2,103,553
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$551
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$330,362
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$539,037
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$2,166,424
Net investment gain or loss from common/collective trusts	2021-12-31	$4,845,974
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
Assets. Invements in employer securities at end of year	2021-12-31	$434,435
Assets. Invements in employer securities at beginning of year	2021-12-31	$718,628
Contributions received in cash from employer	2021-12-31	$707,751
Employer contributions (assets) at end of year	2021-12-31	$31,496
Employer contributions (assets) at beginning of year	2021-12-31	$28,171
Income. Dividends from preferred stock	2021-12-31	$19,378
Income. Dividends from common stock	2021-12-31	$11,002
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$4,190,775
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
Aggregate proceeds on sale of assets	2021-12-31	$406,599
Aggregate carrying amount (costs) on sale of assets	2021-12-31	$422,697
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	S.R. SNODGRASS, P.C
Accountancy firm EIN	2021-12-31	251616561
2020 : AMERISERV FINANCIAL 401K PROFIT SHARING 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$-107,059
Total unrealized appreciation/depreciation of assets	2020-12-31	$-107,059
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	$8,581,264
Total loss/gain on sale of assets	2020-12-31	$-10,683
Total of all expenses incurred	2020-12-31	$3,778,596
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$3,771,702
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$2,184,468
Value of total assets at end of year	2020-12-31	$41,471,941
Value of total assets at beginning of year	2020-12-31	$36,669,273
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$6,894
Total interest from all sources	2020-12-31	$45,771
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$184,851
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$144,308
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
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	$1,361,579
Participant contributions at end of year	2020-12-31	$553,181
Participant contributions at beginning of year	2020-12-31	$565,829
Participant contributions at end of year	2020-12-31	$51,676
Participant contributions at beginning of year	2020-12-31	$52,095
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$173,607
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$3,114
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$6,869
Administrative expenses (other) incurred	2020-12-31	$6,894
Total non interest bearing cash at end of year	2020-12-31	$3,357
Total non interest bearing cash at beginning of year	2020-12-31	$7,931
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	$4,802,668
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$41,471,941
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$36,669,273
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	$15,460,783
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$12,504,923
Interest on participant loans	2020-12-31	$20,131
Interest earned on other investments	2020-12-31	$16,760
Value of interest in common/collective trusts at end of year	2020-12-31	$22,010,441
Value of interest in common/collective trusts at beginning of year	2020-12-31	$19,427,922
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$2,103,553
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$2,359,182
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$2,359,182
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$8,880
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$539,037
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$800,371
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$2,772,741
Net investment gain or loss from common/collective trusts	2020-12-31	$3,511,175
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
Assets. Invements in employer securities at end of year	2020-12-31	$718,628
Assets. Invements in employer securities at beginning of year	2020-12-31	$917,888
Contributions received in cash from employer	2020-12-31	$649,282
Employer contributions (assets) at end of year	2020-12-31	$28,171
Employer contributions (assets) at beginning of year	2020-12-31	$26,263
Income. Dividends from preferred stock	2020-12-31	$28,243
Income. Dividends from common stock	2020-12-31	$12,300
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$3,771,702
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
Aggregate proceeds on sale of assets	2020-12-31	$157,695
Aggregate carrying amount (costs) on sale of assets	2020-12-31	$168,378
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	S.R. SNODGRASS, P.C.
Accountancy firm EIN	2020-12-31	251616561
2019 : AMERISERV FINANCIAL 401K PROFIT SHARING 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$-36,715
Total unrealized appreciation/depreciation of assets	2019-12-31	$-36,715
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	$8,312,966
Total loss/gain on sale of assets	2019-12-31	$64,329
Total of all expenses incurred	2019-12-31	$3,009,474
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$3,004,694
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$2,227,812
Value of total assets at end of year	2019-12-31	$36,669,273
Value of total assets at beginning of year	2019-12-31	$31,365,781
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$4,780
Total interest from all sources	2019-12-31	$81,655
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$207,911
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$157,551
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,298,025
Participant contributions at end of year	2019-12-31	$565,829
Participant contributions at beginning of year	2019-12-31	$551,049
Participant contributions at end of year	2019-12-31	$52,095
Participant contributions at beginning of year	2019-12-31	$48,620
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$325,557
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$6,869
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$6,605
Administrative expenses (other) incurred	2019-12-31	$4,780
Total non interest bearing cash at end of year	2019-12-31	$7,931
Total non interest bearing cash at beginning of year	2019-12-31	$11,189
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	$5,303,492
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$36,669,273
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$31,365,781
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$12,504,923
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$9,432,392
Interest on participant loans	2019-12-31	$20,696
Interest earned on other investments	2019-12-31	$27,308
Value of interest in common/collective trusts at end of year	2019-12-31	$19,427,922
Value of interest in common/collective trusts at beginning of year	2019-12-31	$17,617,309
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$2,359,182
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$1,589,574
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$1,589,574
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$33,651
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$800,371
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$859,755
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$2,455,060
Net investment gain or loss from common/collective trusts	2019-12-31	$3,312,914
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
Assets. Invements in employer securities at end of year	2019-12-31	$917,888
Assets. Invements in employer securities at beginning of year	2019-12-31	$1,226,647
Contributions received in cash from employer	2019-12-31	$604,230
Employer contributions (assets) at end of year	2019-12-31	$26,263
Employer contributions (assets) at beginning of year	2019-12-31	$22,641
Income. Dividends from preferred stock	2019-12-31	$38,827
Income. Dividends from common stock	2019-12-31	$11,533
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$3,004,694
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
Aggregate proceeds on sale of assets	2019-12-31	$384,502
Aggregate carrying amount (costs) on sale of assets	2019-12-31	$320,173
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	S.R SNODGRASS, P.C.
Accountancy firm EIN	2019-12-31	251616561
2018 : AMERISERV FINANCIAL 401K PROFIT SHARING 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$21,441
Total unrealized appreciation/depreciation of assets	2018-12-31	$21,441
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	$1,114
Total income from all sources (including contributions)	2018-12-31	$1,081,371
Total loss/gain on sale of assets	2018-12-31	$30,501
Total of all expenses incurred	2018-12-31	$3,856,059
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$3,837,610
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$2,103,576
Value of total assets at end of year	2018-12-31	$31,365,781
Value of total assets at beginning of year	2018-12-31	$34,141,583
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$18,449
Total interest from all sources	2018-12-31	$56,722
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$197,558
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$142,482
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
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	$1,181,501
Participant contributions at end of year	2018-12-31	$551,049
Participant contributions at beginning of year	2018-12-31	$582,072
Participant contributions at end of year	2018-12-31	$48,620
Participant contributions at beginning of year	2018-12-31	$52,494
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$419,436
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$6,605
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$3,576
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$1,114
Administrative expenses (other) incurred	2018-12-31	$18,449
Total non interest bearing cash at end of year	2018-12-31	$11,189
Total non interest bearing cash at beginning of year	2018-12-31	$13,555
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	$-2,774,688
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$31,365,781
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$34,140,469
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$9,432,392
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$10,959,674
Interest on participant loans	2018-12-31	$17,843
Interest earned on other investments	2018-12-31	$20,206
Value of interest in common/collective trusts at end of year	2018-12-31	$17,617,309
Value of interest in common/collective trusts at beginning of year	2018-12-31	$18,962,082
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$1,589,574
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$1,166,550
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$1,166,550
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$18,673
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$859,755
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,239,692
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-693,927
Net investment gain or loss from common/collective trusts	2018-12-31	$-634,500
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Assets. Invements in employer securities at end of year	2018-12-31	$1,226,647
Assets. Invements in employer securities at beginning of year	2018-12-31	$1,139,810
Contributions received in cash from employer	2018-12-31	$502,639
Employer contributions (assets) at end of year	2018-12-31	$22,641
Employer contributions (assets) at beginning of year	2018-12-31	$22,078
Income. Dividends from preferred stock	2018-12-31	$46,975
Income. Dividends from common stock	2018-12-31	$8,101
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$3,837,610
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	$305,022
Aggregate carrying amount (costs) on sale of assets	2018-12-31	$274,521
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	S.R. SNODGRASS
Accountancy firm EIN	2018-12-31	251616561
2017 : AMERISERV FINANCIAL 401K PROFIT SHARING 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$121,680
Total unrealized appreciation/depreciation of assets	2017-12-31	$121,680
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$1,114
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	$6,467,042
Total loss/gain on sale of assets	2017-12-31	$28,443
Total of all expenses incurred	2017-12-31	$1,724,993
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,724,993
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,764,656
Value of total assets at end of year	2017-12-31	$34,141,583
Value of total assets at beginning of year	2017-12-31	$29,398,420
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$0
Total interest from all sources	2017-12-31	$40,019
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$203,291
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$137,641
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
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	$1,086,484
Participant contributions at end of year	2017-12-31	$582,072
Participant contributions at beginning of year	2017-12-31	$480,785
Participant contributions at end of year	2017-12-31	$52,494
Participant contributions at beginning of year	2017-12-31	$49,260
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$208,636
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$3,576
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$3,031
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$1,114
Total non interest bearing cash at end of year	2017-12-31	$13,555
Total non interest bearing cash at beginning of year	2017-12-31	$16,018
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	$4,742,049
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$34,140,469
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$29,398,420
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$10,959,674
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$8,582,460
Interest on participant loans	2017-12-31	$16,368
Interest earned on other investments	2017-12-31	$13,758
Value of interest in common/collective trusts at end of year	2017-12-31	$18,962,082
Value of interest in common/collective trusts at beginning of year	2017-12-31	$16,120,354
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$1,166,550
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$1,706,282
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$1,706,282
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$9,893
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,239,692
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,166,329
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$1,701,775
Net investment gain or loss from common/collective trusts	2017-12-31	$2,607,178
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	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Assets. Invements in employer securities at end of year	2017-12-31	$1,139,810
Assets. Invements in employer securities at beginning of year	2017-12-31	$1,250,990
Contributions received in cash from employer	2017-12-31	$469,536
Employer contributions (assets) at end of year	2017-12-31	$22,078
Employer contributions (assets) at beginning of year	2017-12-31	$22,911
Income. Dividends from preferred stock	2017-12-31	$58,623
Income. Dividends from common stock	2017-12-31	$7,027
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$1,724,993
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
Aggregate proceeds on sale of assets	2017-12-31	$365,099
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$336,656
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	S. R. SNODGRASS
Accountancy firm EIN	2017-12-31	251616561
2016 : AMERISERV FINANCIAL 401K PROFIT SHARING 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$78,898
Total unrealized appreciation/depreciation of assets	2016-12-31	$78,898
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$3,114,686
Total loss/gain on sale of assets	2016-12-31	$1,494
Total of all expenses incurred	2016-12-31	$1,816,273
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,816,273
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,552,005
Value of total assets at end of year	2016-12-31	$29,398,420
Value of total assets at beginning of year	2016-12-31	$28,100,007
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$19,159
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$198,327
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$133,197
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,044,891
Participant contributions at end of year	2016-12-31	$480,785
Participant contributions at beginning of year	2016-12-31	$421,296
Participant contributions at end of year	2016-12-31	$49,260
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$59,752
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$3,031
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$2,112
Total non interest bearing cash at end of year	2016-12-31	$16,018
Total non interest bearing cash at beginning of year	2016-12-31	$21,616
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$1,298,413
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$29,398,420
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$28,100,007
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$8,582,460
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$7,448,220
Interest on participant loans	2016-12-31	$13,918
Value of interest in common/collective trusts at end of year	2016-12-31	$16,120,354
Value of interest in common/collective trusts at beginning of year	2016-12-31	$16,041,202
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$1,706,282
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$1,522,148
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$1,522,148
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$5,241
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,166,329
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,209,170
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$443,509
Net investment gain or loss from common/collective trusts	2016-12-31	$821,294
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Assets. Invements in employer securities at end of year	2016-12-31	$1,250,990
Assets. Invements in employer securities at beginning of year	2016-12-31	$1,434,243
Contributions received in cash from employer	2016-12-31	$447,362
Employer contributions (assets) at end of year	2016-12-31	$22,911
Income. Dividends from preferred stock	2016-12-31	$59,074
Income. Dividends from common stock	2016-12-31	$6,056
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,816,273
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Aggregate proceeds on sale of assets	2016-12-31	$41,498
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$40,004
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	S. R. SNODGRASS
Accountancy firm EIN	2016-12-31	251616561
2015 : AMERISERV FINANCIAL 401K PROFIT SHARING 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$-117,455
Total unrealized appreciation/depreciation of assets	2015-12-31	$-117,455
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	$94,600
Total income from all sources (including contributions)	2015-12-31	$1,602,970
Total loss/gain on sale of assets	2015-12-31	$18,909
Total of all expenses incurred	2015-12-31	$2,192,608
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$2,192,608
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,504,047
Value of total assets at end of year	2015-12-31	$28,100,007
Value of total assets at beginning of year	2015-12-31	$28,784,245
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$12,837
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$212,329
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$142,131
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
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
Contributions received from participants	2015-12-31	$1,027,979
Participant contributions at end of year	2015-12-31	$421,296
Participant contributions at beginning of year	2015-12-31	$344,043
Participant contributions at beginning of year	2015-12-31	$34,696
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$42,864
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$2,112
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$6,677
Total non interest bearing cash at end of year	2015-12-31	$21,616
Total non interest bearing cash at beginning of year	2015-12-31	$14,557
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	$-589,638
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$28,100,007
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$28,689,645
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 registered invesment companies (eg mutual funds) at end of year	2015-12-31	$7,448,220
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$8,353,122
Interest on participant loans	2015-12-31	$12,049
Value of interest in common/collective trusts at end of year	2015-12-31	$16,041,202
Value of interest in common/collective trusts at beginning of year	2015-12-31	$16,513,146
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$1,522,148
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$1,211,027
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$1,211,027
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$788
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,209,170
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,203,628
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$39,956
Net investment gain or loss from common/collective trusts	2015-12-31	$-67,653
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
Assets. Invements in employer securities at end of year	2015-12-31	$1,434,243
Assets. Invements in employer securities at beginning of year	2015-12-31	$1,087,447
Contributions received in cash from employer	2015-12-31	$433,204
Employer contributions (assets) at beginning of year	2015-12-31	$15,902
Income. Dividends from preferred stock	2015-12-31	$65,731
Income. Dividends from common stock	2015-12-31	$4,467
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$2,192,608
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$94,600
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
Aggregate proceeds on sale of assets	2015-12-31	$516,930
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$498,021
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	S. R. SNODGRASS
Accountancy firm EIN	2015-12-31	251616561
2014 : AMERISERV FINANCIAL 401K PROFIT SHARING 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$101,683
Total unrealized appreciation/depreciation of assets	2014-12-31	$101,683
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$94,600
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	$3,950,712
Total loss/gain on sale of assets	2014-12-31	$2,136,816
Total of all expenses incurred	2014-12-31	$5,662,962
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$5,662,962
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,580,221
Value of total assets at end of year	2014-12-31	$28,784,245
Value of total assets at beginning of year	2014-12-31	$30,401,895
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$12,843
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$196,187
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$147,770
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
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	$1,065,227
Participant contributions at end of year	2014-12-31	$344,043
Participant contributions at beginning of year	2014-12-31	$336,859
Participant contributions at end of year	2014-12-31	$34,696
Participant contributions at beginning of year	2014-12-31	$39,329
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$128,925
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$6,677
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$4,080
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$14,557
Total non interest bearing cash at beginning of year	2014-12-31	$197,160
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	$-1,712,250
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$28,689,645
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$30,401,895
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 registered invesment companies (eg mutual funds) at end of year	2014-12-31	$8,353,122
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$8,549,525
Interest on participant loans	2014-12-31	$12,456
Interest earned on other investments	2014-12-31	$103
Value of interest in common/collective trusts at end of year	2014-12-31	$16,513,146
Value of interest in common/collective trusts at beginning of year	2014-12-31	$17,682,221
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$1,211,027
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$1,858,560
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$1,858,560
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$284
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,203,628
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$918,318
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$58,494
Net investment gain or loss from common/collective trusts	2014-12-31	$-135,532
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
Assets. Invements in employer securities at end of year	2014-12-31	$1,087,447
Assets. Invements in employer securities at beginning of year	2014-12-31	$801,539
Contributions received in cash from employer	2014-12-31	$386,069
Employer contributions (assets) at end of year	2014-12-31	$15,902
Employer contributions (assets) at beginning of year	2014-12-31	$14,304
Income. Dividends from preferred stock	2014-12-31	$44,110
Income. Dividends from common stock	2014-12-31	$4,307
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$5,662,962
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$94,600
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
Aggregate proceeds on sale of assets	2014-12-31	$11,304,849
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$9,168,033
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	S. R. SNODGRASS
Accountancy firm EIN	2014-12-31	251616561
2013 : AMERISERV FINANCIAL 401K PROFIT SHARING 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$42,661
Total unrealized appreciation/depreciation of assets	2013-12-31	$42,661
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$6,591,089
Total loss/gain on sale of assets	2013-12-31	$1,695,186
Total of all expenses incurred	2013-12-31	$1,140,555
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,140,555
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,066,702
Value of total assets at end of year	2013-12-31	$30,401,895
Value of total assets at beginning of year	2013-12-31	$24,951,361
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$18,196
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$415,417
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$372,697
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,025,498
Participant contributions at end of year	2013-12-31	$336,859
Participant contributions at beginning of year	2013-12-31	$404,944
Participant contributions at end of year	2013-12-31	$39,329
Participant contributions at beginning of year	2013-12-31	$35,966
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$722,034
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$4,080
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$4,491
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Total non interest bearing cash at end of year	2013-12-31	$197,160
Total non interest bearing cash at beginning of year	2013-12-31	$10,286
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$5,450,534
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$30,401,895
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$24,951,361
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$8,549,525
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$6,691,794
Interest on participant loans	2013-12-31	$17,276
Interest earned on other investments	2013-12-31	$205
Value of interest in common/collective trusts at end of year	2013-12-31	$17,682,221
Value of interest in common/collective trusts at beginning of year	2013-12-31	$14,887,333
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$1,858,560
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$1,879,476
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$1,879,476
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$715
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$918,318
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$111,818
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$348,447
Net investment gain or loss from common/collective trusts	2013-12-31	$2,004,480
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$801,539
Assets. Invements in employer securities at beginning of year	2013-12-31	$913,830
Contributions received in cash from employer	2013-12-31	$319,170
Employer contributions (assets) at end of year	2013-12-31	$14,304
Employer contributions (assets) at beginning of year	2013-12-31	$11,423
Income. Dividends from preferred stock	2013-12-31	$38,977
Income. Dividends from common stock	2013-12-31	$3,743
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,140,555
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$11,003,101
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$9,307,915
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	S. R. SNODGRASS
Accountancy firm EIN	2013-12-31	251616561
2012 : AMERISERV FINANCIAL 401K PROFIT SHARING 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$112,419
Total unrealized appreciation/depreciation of assets	2012-12-31	$112,419
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$4,056,631
Total loss/gain on sale of assets	2012-12-31	$745,814
Total of all expenses incurred	2012-12-31	$2,722,649
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$2,722,649
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,364,785
Value of total assets at end of year	2012-12-31	$24,951,361
Value of total assets at beginning of year	2012-12-31	$23,617,379
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$9,134
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$270,979
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$239,732
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$934,208
Participant contributions at end of year	2012-12-31	$404,944
Participant contributions at beginning of year	2012-12-31	$340,120
Participant contributions at end of year	2012-12-31	$35,966
Participant contributions at beginning of year	2012-12-31	$35,136
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$162,212
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$4,491
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$8,827
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$0
Total non interest bearing cash at end of year	2012-12-31	$10,286
Total non interest bearing cash at beginning of year	2012-12-31	$4,658
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$1,333,982
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$24,951,361
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$23,617,379
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$6,691,794
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$7,084,569
Interest on participant loans	2012-12-31	$19,780
Interest earned on other investments	2012-12-31	$-11,917
Value of interest in common/collective trusts at end of year	2012-12-31	$14,887,333
Value of interest in common/collective trusts at beginning of year	2012-12-31	$11,349,958
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$1,879,476
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$4,325,762
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$4,325,762
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$1,271
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$111,818
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$647,411
Net investment gain or loss from common/collective trusts	2012-12-31	$906,089
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Assets. Invements in employer securities at end of year	2012-12-31	$913,830
Assets. Invements in employer securities at beginning of year	2012-12-31	$457,463
Contributions received in cash from employer	2012-12-31	$268,365
Employer contributions (assets) at end of year	2012-12-31	$11,423
Employer contributions (assets) at beginning of year	2012-12-31	$10,886
Income. Dividends from preferred stock	2012-12-31	$31,247
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$2,722,649
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$10,903,031
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$10,157,217
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	S. R. SNODGRASS
Accountancy firm EIN	2012-12-31	251616561
2011 : AMERISERV FINANCIAL 401K PROFIT SHARING 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$85,784
Total unrealized appreciation/depreciation of assets	2011-12-31	$85,784
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$985,704
Total loss/gain on sale of assets	2011-12-31	$396,848
Total of all expenses incurred	2011-12-31	$1,518,091
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,518,091
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,257,422
Value of total assets at end of year	2011-12-31	$23,617,379
Value of total assets at beginning of year	2011-12-31	$24,149,766
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$40,332
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$228,363
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$219,834
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$919,805
Participant contributions at end of year	2011-12-31	$340,120
Participant contributions at beginning of year	2011-12-31	$381,203
Participant contributions at end of year	2011-12-31	$35,136
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$108,890
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$8,827
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$5,405
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$0
Total non interest bearing cash at end of year	2011-12-31	$4,658
Total non interest bearing cash at beginning of year	2011-12-31	$1,563
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-532,387
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$23,617,379
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$24,149,766
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$7,084,569
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$10,712,052
Interest on participant loans	2011-12-31	$20,015
Interest earned on other investments	2011-12-31	$15,138
Value of interest in common/collective trusts at end of year	2011-12-31	$11,349,958
Value of interest in common/collective trusts at beginning of year	2011-12-31	$10,735,044
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$4,325,762
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$2,056,374
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$2,056,374
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$5,179
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-577,779
Net investment gain or loss from common/collective trusts	2011-12-31	$-445,266
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Assets. Invements in employer securities at end of year	2011-12-31	$457,463
Assets. Invements in employer securities at beginning of year	2011-12-31	$258,125
Contributions received in cash from employer	2011-12-31	$228,727
Employer contributions (assets) at end of year	2011-12-31	$10,886
Income. Dividends from preferred stock	2011-12-31	$8,529
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,518,091
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$6,264,218
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$5,867,370
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	S.R. SNODGRASS
Accountancy firm EIN	2011-12-31	251616561
2010 : AMERISERV FINANCIAL 401K PROFIT SHARING 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$31,341
Total unrealized appreciation/depreciation of assets	2010-12-31	$31,341
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$20,595
Total income from all sources (including contributions)	2010-12-31	$3,382,154
Total loss/gain on sale of assets	2010-12-31	$295,697
Total of all expenses incurred	2010-12-31	$1,151,472
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,151,472
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,135,557
Value of total assets at end of year	2010-12-31	$24,149,766
Value of total assets at beginning of year	2010-12-31	$21,939,679
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$26,606
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$204,880
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$198,823
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$860,237
Participant contributions at end of year	2010-12-31	$381,203
Participant contributions at beginning of year	2010-12-31	$370,407
Participant contributions at beginning of year	2010-12-31	$27,502
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$80,272
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$5,405
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$12,727
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$20,595
Total non interest bearing cash at end of year	2010-12-31	$1,563
Total non interest bearing cash at beginning of year	2010-12-31	$6,132
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$2,230,682
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$24,149,766
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$21,919,084
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$10,712,052
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$9,762,566
Income. Interest from loans (other than to participants)	2010-12-31	$23,621
Interest earned on other investments	2010-12-31	$105
Value of interest in common/collective trusts at end of year	2010-12-31	$10,735,044
Value of interest in common/collective trusts at beginning of year	2010-12-31	$8,377,202
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$2,056,374
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$3,085,316
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$3,085,316
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$2,880
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$653,120
Net investment gain or loss from common/collective trusts	2010-12-31	$1,034,953
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Assets. Invements in employer securities at end of year	2010-12-31	$258,125
Assets. Invements in employer securities at beginning of year	2010-12-31	$289,617
Contributions received in cash from employer	2010-12-31	$195,048
Employer contributions (assets) at beginning of year	2010-12-31	$8,210
Income. Dividends from preferred stock	2010-12-31	$6,057
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,151,472
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$7,702,935
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$7,407,238
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	S.R. SNODGRASS
Accountancy firm EIN	2010-12-31	251616561
2009 : AMERISERV FINANCIAL 401K PROFIT SHARING 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for AMERISERV FINANCIAL 401K PROFIT SHARING

2022: AMERISERV FINANCIAL 401K PROFIT SHARING 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	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 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	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 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	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 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	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 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	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 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	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: AMERISERV FINANCIAL 401K PROFIT SHARING 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
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: AMERISERV FINANCIAL 401K PROFIT SHARING 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
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	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: AMERISERV FINANCIAL 401K PROFIT SHARING 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: AMERISERV FINANCIAL 401K PROFIT SHARING 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: AMERISERV FINANCIAL 401K PROFIT SHARING 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	3
Insurance contract or identification number BA3502824 Number of Individuals Covered 2 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 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
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 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
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	1
Insurance contract or identification number MULTIPLE Number of Individuals Covered 2 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 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
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	3
Insurance contract or identification number BA3502824 Number of Individuals Covered 2 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
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 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
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	1
Insurance contract or identification number MULTIPLE Number of Individuals Covered 2 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
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number	MULTIPLE
Policy instance	1
Insurance contract or identification number MULTIPLE Number of Individuals Covered 3 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
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 2 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 Insurance broker organization code? 3
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	3
Insurance contract or identification number MULTIPLE Number of Individuals Covered 5 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
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	4
Insurance contract or identification number BA3502824 Number of Individuals Covered 2 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
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number	212002212
Policy instance	1
Insurance contract or identification number 212002212 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 $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
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 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 $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
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	3
Insurance contract or identification number MULTIPLE Number of Individuals Covered 3 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 $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 Insurance broker organization code? 3
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	4
Insurance contract or identification number MULTIPLE Number of Individuals Covered 6 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 $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
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	5
Insurance contract or identification number BA3502824 Number of Individuals Covered 3 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 $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
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	4
Insurance contract or identification number MULTIPLE 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? 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
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	5
Insurance contract or identification number BA3502824 Number of Individuals Covered 3 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? 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
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	3
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 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? 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 Insurance broker organization code? 3
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 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? 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
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number	212002212
Policy instance	1
Insurance contract or identification number 212002212 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 $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
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	5
Insurance contract or identification number BA3502824 Number of Individuals Covered 3 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 $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
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	4
Insurance contract or identification number MULTIPLE Number of Individuals Covered 13 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 $35 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 Amount paid for insurance broker fees 35 Additional information about fees paid to insurance broker FEES AND OTHER EXPENSES Insurance broker organization code? 3 Insurance broker name L.P.L. FINANICAL LLC
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	3
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 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 $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 Insurance broker organization code? 3 Insurance broker name
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 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 $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
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number	212002212
Policy instance	1
Insurance contract or identification number 212002212 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 $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
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number	212002212
Policy instance	1
Insurance contract or identification number 212002212 Number of Individuals Covered 1 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 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? Yes 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
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 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? Yes 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
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	3
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 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? Yes 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 Insurance broker organization code? 3 Insurance broker name
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	5
Insurance contract or identification number BA3502824 Number of Individuals Covered 3 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 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? Yes 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
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	4
Insurance contract or identification number MULTIPLE Number of Individuals Covered 12 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $3,688 Total amount of fees paid to insurance company USD $707 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $3,688 Amount paid for insurance broker fees 707 Additional information about fees paid to insurance broker FEES AND OTHER EXPENSES Insurance broker organization code? 3 Insurance broker name L.P.L. FINANICAL LLC
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	1
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 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? Yes 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 Insurance broker organization code? 3 Insurance broker name
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number	212002212
Policy instance	2
Insurance contract or identification number 212002212 Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $35 Are there contracts with allocated funds for individual policies? Yes 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 Amount paid for insurance broker fees 35 Additional information about fees paid to insurance broker OTHER COST AND EXPENSES Insurance broker organization code? 3 Insurance broker name
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	3
Insurance contract or identification number BA3502824 Number of Individuals Covered 3 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 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? Yes 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 Insurance broker organization code? 3 Insurance broker name
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number	MULTIPLE
Policy instance	4
Insurance contract or identification number MULTIPLE Number of Individuals Covered 5 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 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? Yes 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
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	5
Insurance contract or identification number MULTIPLE Number of Individuals Covered 8 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $6,040 Total amount of fees paid to insurance company USD $552 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $6,040 Amount paid for insurance broker fees 552 Additional information about fees paid to insurance broker FEES AND OTHER EXPENSES Insurance broker organization code? 3 Insurance broker name L.P.L. FINANICAL LLC
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract number	MULTIPLE
Policy instance	5
Insurance contract or identification number MULTIPLE Number of Individuals Covered 6 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $16,600 Total amount of fees paid to insurance company USD $435 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $16,600 Amount paid for insurance broker fees 435 Additional information about fees paid to insurance broker FEES AND OTHER EXPENSES Insurance broker organization code? 3 Insurance broker name L.P.L. FINANICAL LLC
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number	MULTIPLE
Policy instance	4
Insurance contract or identification number MULTIPLE Number of Individuals Covered 5 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $17,085 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $17,085 Insurance broker organization code? 3 Insurance broker name RICKY A KALANISH
PROTECTIVE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88536 )
Policy contract number	BA3502824
Policy instance	3
Insurance contract or identification number BA3502824 Number of Individuals Covered 1 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $5,950 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $2,975 Insurance broker organization code? 3 Insurance broker name MATTHEW FOX
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number	212002212
Policy instance	2
Insurance contract or identification number 212002212 Number of Individuals Covered 1 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $35 Are there contracts with allocated funds for individual policies? Yes 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 Amount paid for insurance broker fees 35 Additional information about fees paid to insurance broker OTHER COST AND EXPENSES Insurance broker organization code? 3 Insurance broker name
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	1
Insurance contract or identification number MULTIPLE Number of Individuals Covered 4 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $400 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $400 Insurance broker organization code? 3 Insurance broker name RICKY KALANISH
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number	MULTIPLE
Policy instance	2
Insurance contract or identification number MULTIPLE Number of Individuals Covered 1 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $3,600 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $1,224 Insurance broker organization code? 3 Insurance broker name JARED DYKES
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	MULTIPLE
Policy instance	1
Insurance contract or identification number MULTIPLE Number of Individuals Covered 3 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $2,500 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 Commission paid to Insurance Broker USD $850 Insurance broker organization code? 3 Insurance broker name MATTHEW FOX