401k Plan data: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST plan

RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan Name	RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number	001

RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

RC JENSON INC DBA JENSON USA has sponsored the creation of one or more 401k plans.

Company Name: RC JENSON INC DBA JENSON USA

Employer identification number (EIN): 330792981

NAIC Classification: 451110
NAIC Description: Sporting Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01
001 2021-01-01 ALLISON C. MIZELL 2022-10-03 ALLISON C. MIZELL 2022-10-03
001 2020-01-01 ALLISON C. MIZELL 2021-10-07 ALLISON C. MIZELL 2021-10-07
001 2019-01-01 ALLISON C. MIZELL 2020-10-13 ALLISON C. MIZELL 2020-10-13
001 2018-01-01 MIKE CACHAT 2019-10-03 MIKE CACHAT 2019-10-03
001 2017-01-01
001 2016-01-01
001 2015-01-01 MICHAEL CACHAT 2016-07-25
001 2014-01-01 MICHAEL CACHAT 2015-07-27
001 2013-01-01 DAVID BLADES 2014-07-15
001 2012-01-01 RC JENSEN INC 2013-07-24
001 2011-01-01 RC JENSEN INC 2012-07-31
001 2010-03-01 RC JENSEN INC 2011-10-14
001 2009-03-01 MICHAEL CACHAT 2010-12-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01
001	2022-01-01
001	2021-01-01	ALLISON C. MIZELL	2022-10-03	ALLISON C. MIZELL	2022-10-03
001	2020-01-01	ALLISON C. MIZELL	2021-10-07	ALLISON C. MIZELL	2021-10-07
001	2019-01-01	ALLISON C. MIZELL	2020-10-13	ALLISON C. MIZELL	2020-10-13
001	2018-01-01	MIKE CACHAT	2019-10-03	MIKE CACHAT	2019-10-03
001	2017-01-01
001	2016-01-01
001	2015-01-01	MICHAEL CACHAT	2016-07-25
001	2014-01-01	MICHAEL CACHAT	2015-07-27
001	2013-01-01	DAVID BLADES	2014-07-15
001	2012-01-01	RC JENSEN INC	2013-07-24
001	2011-01-01	RC JENSEN INC	2012-07-31
001	2010-03-01	RC JENSEN INC	2011-10-14
001	2009-03-01	MICHAEL CACHAT	2010-12-02

Plan Statistics for RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2023: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2023 401k membership
Total participants, beginning-of-year 2023-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 88
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 49
Total of all active and inactive participants 2023-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 137
Number of participants with account balances 2023-01-01 121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 0
2022: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year 2022-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 87
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 48
Total of all active and inactive participants 2022-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 135
Number of participants with account balances 2022-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year 2021-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 108
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 30
Total of all active and inactive participants 2021-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 138
Number of participants with account balances 2021-01-01 131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year 2020-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 119
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 22
Total of all active and inactive participants 2020-01-01 141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 141
Number of participants with account balances 2020-01-01 139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year 2019-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 91
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 22
Total of all active and inactive participants 2019-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 113
Number of participants with account balances 2019-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year 2018-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 110
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 21
Total of all active and inactive participants 2018-01-01 131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 131
Number of participants with account balances 2018-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year 2017-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 109
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 21
Total of all active and inactive participants 2017-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 130
Number of participants with account balances 2017-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0

Measure	Date	Value
2023: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2023 401k membership
Total participants, beginning-of-year	2023-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	88
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	49
Total of all active and inactive participants	2023-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	137
Number of participants with account balances	2023-01-01	121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	0
2022: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year	2022-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	87
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	48
Total of all active and inactive participants	2022-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	135
Number of participants with account balances	2022-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year	2021-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	108
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	30
Total of all active and inactive participants	2021-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	138
Number of participants with account balances	2021-01-01	131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year	2020-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	119
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	22
Total of all active and inactive participants	2020-01-01	141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	141
Number of participants with account balances	2020-01-01	139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	91
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	22
Total of all active and inactive participants	2019-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	113
Number of participants with account balances	2019-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	110
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	21
Total of all active and inactive participants	2018-01-01	131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	131
Number of participants with account balances	2018-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	109
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	21
Total of all active and inactive participants	2017-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	130
Number of participants with account balances	2017-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0

Financial Data on RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST

Measure	Date	Value
2023 : RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$15
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$1,258,514
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$183,893
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$169,125
Value of total corrective distributions	2023-12-31	$15
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$380,079
Value of total assets at end of year	2023-12-31	$5,770,537
Value of total assets at beginning of year	2023-12-31	$4,695,901
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$14,753
Total interest from all sources	2023-12-31	$3,785
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$500,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$276,736
Participant contributions at end of year	2023-12-31	$0
Participant contributions at beginning of year	2023-12-31	$0
Assets. Loans (other than to participants) at end of year	2023-12-31	$54,670
Assets. Loans (other than to participants) at beginning of year	2023-12-31	$66,558
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2023-12-31	$15
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2023-12-31	$0
Administrative expenses (other) incurred	2023-12-31	$13,413
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$1,074,621
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$5,770,522
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$4,695,901
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Value of interest in pooled separate accounts at end of year	2023-12-31	$5,684,403
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$4,596,665
Interest on participant loans	2023-12-31	$3,631
Interest earned on other investments	2023-12-31	$154
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$31,464
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$32,678
Net investment gain/loss from pooled separate accounts	2023-12-31	$874,650
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	No
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$103,343
Employer contributions (assets) at end of year	2023-12-31	$0
Employer contributions (assets) at beginning of year	2023-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$169,125
Contract administrator fees	2023-12-31	$1,340
Did the plan have assets held for investment	2023-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	ROORDA, PIQUET & BESSEE INC.
Accountancy firm EIN	2023-12-31	330252865
2022 : RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-582,025
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$190,188
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$175,437
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$523,156
Value of total assets at end of year	2022-12-31	$4,695,901
Value of total assets at beginning of year	2022-12-31	$5,468,114
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$14,751
Total interest from all sources	2022-12-31	$2,929
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$2,625
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$331,766
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Assets. Loans (other than to participants) at end of year	2022-12-31	$66,558
Assets. Loans (other than to participants) at beginning of year	2022-12-31	$33,951
Administrative expenses (other) incurred	2022-12-31	$12,126
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	$-772,213
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,695,901
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,468,114
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$4,596,665
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$5,407,100
Income. Interest from loans (other than to participants)	2022-12-31	$2,865
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$64
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$32,678
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$27,063
Net investment gain/loss from pooled separate accounts	2022-12-31	$-1,108,110
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$191,390
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$175,437
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	ROORDA, PIQUET & BESSEE INC.
Accountancy firm EIN	2022-12-31	330252865
2021 : RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,142,026
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$529,133
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$477,823
Expenses. Certain deemed distributions of participant loans	2021-12-31	$34,366
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$515,338
Value of total assets at end of year	2021-12-31	$5,468,114
Value of total assets at beginning of year	2021-12-31	$4,855,221
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$16,944
Total interest from all sources	2021-12-31	$2,510
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$328,260
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$1,243
Assets. Loans (other than to participants) at end of year	2021-12-31	$33,951
Assets. Loans (other than to participants) at beginning of year	2021-12-31	$27,787
Administrative expenses (other) incurred	2021-12-31	$0
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
Income. Non cash contributions	2021-12-31	$0
Value of net income/loss	2021-12-31	$612,893
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,468,114
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,855,221
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
Investment advisory and management fees	2021-12-31	$13,064
Value of interest in pooled separate accounts at end of year	2021-12-31	$5,407,100
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$4,404,235
Interest on participant loans	2021-12-31	$2,422
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$88
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$27,063
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$16,505
Net investment gain/loss from pooled separate accounts	2021-12-31	$624,178
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$185,835
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$406,694
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$477,823
Contract administrator fees	2021-12-31	$3,880
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	ROORDA, PIQUET & BESSEE INC.
Accountancy firm EIN	2021-12-31	330252865
2020 : RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,645,555
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$84,920
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$74,510
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$882,539
Value of total assets at end of year	2020-12-31	$4,855,221
Value of total assets at beginning of year	2020-12-31	$3,294,586
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$10,410
Total interest from all sources	2020-12-31	$2,554
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$266,055
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$0
Assets. Loans (other than to participants) at end of year	2020-12-31	$27,787
Assets. Loans (other than to participants) at beginning of year	2020-12-31	$45,506
Administrative expenses (other) incurred	2020-12-31	$0
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
Income. Non cash contributions	2020-12-31	$64,593
Value of net income/loss	2020-12-31	$1,560,635
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,855,221
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,294,586
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
Investment advisory and management fees	2020-12-31	$9,139
Value of interest in pooled separate accounts at end of year	2020-12-31	$4,404,235
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$3,239,907
Interest on participant loans	2020-12-31	$2,443
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$111
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$16,505
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$9,173
Net investment gain/loss from pooled separate accounts	2020-12-31	$760,462
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$551,891
Employer contributions (assets) at end of year	2020-12-31	$406,694
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$74,510
Contract administrator fees	2020-12-31	$1,271
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	ROORDA, PIQUET & BESSEE INC.
Accountancy firm EIN	2020-12-31	330252865
2019 : RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$920,382
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$473,650
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$462,201
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$358,678
Value of total assets at end of year	2019-12-31	$3,294,586
Value of total assets at beginning of year	2019-12-31	$2,847,854
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$11,449
Total interest from all sources	2019-12-31	$2,882
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$233,707
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Assets. Loans (other than to participants) at end of year	2019-12-31	$45,506
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$35,695
Administrative expenses (other) incurred	2019-12-31	$0
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	$446,732
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,294,586
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,847,854
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$8,003
Value of interest in pooled separate accounts at end of year	2019-12-31	$3,239,907
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$2,812,159
Interest on participant loans	2019-12-31	$2,789
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$93
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$9,173
Net investment gain/loss from pooled separate accounts	2019-12-31	$558,822
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$124,971
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$462,201
Contract administrator fees	2019-12-31	$3,446
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	ROORDA, PIQUET & BESSEE INC.
Accountancy firm EIN	2019-12-31	330252865
2018 : RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$218,388
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$222,981
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$213,544
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$427,952
Value of total assets at end of year	2018-12-31	$2,847,854
Value of total assets at beginning of year	2018-12-31	$2,852,447
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$9,437
Total interest from all sources	2018-12-31	$1,852
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$250,000
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	$266,019
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$16,179
Assets. Loans (other than to participants) at end of year	2018-12-31	$35,695
Assets. Loans (other than to participants) at beginning of year	2018-12-31	$41,245
Administrative expenses (other) incurred	2018-12-31	$0
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	$-4,593
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,847,854
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,852,447
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$7,577
Value of interest in pooled separate accounts at end of year	2018-12-31	$2,812,159
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$2,811,202
Interest on participant loans	2018-12-31	$1,809
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$43
Net investment gain/loss from pooled separate accounts	2018-12-31	$-211,416
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
Contributions received in cash from employer	2018-12-31	$145,754
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$213,544
Contract administrator fees	2018-12-31	$1,860
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	ROORDA, PIQUET & BESSEE INC.
Accountancy firm EIN	2018-12-31	330252865
2017 : RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$728,690
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$90,353
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$79,526
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$356,575
Value of total assets at end of year	2017-12-31	$2,852,447
Value of total assets at beginning of year	2017-12-31	$2,214,110
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$10,827
Total interest from all sources	2017-12-31	$2,230
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$250,000
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	$228,060
Participant contributions at beginning of year	2017-12-31	$50
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Assets. Loans (other than to participants) at end of year	2017-12-31	$41,245
Assets. Loans (other than to participants) at beginning of year	2017-12-31	$47,548
Administrative expenses (other) incurred	2017-12-31	$0
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	$638,337
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,852,447
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,214,110
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$9,398
Value of interest in pooled separate accounts at end of year	2017-12-31	$2,811,202
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,166,462
Interest on participant loans	2017-12-31	$2,222
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$8
Net investment gain/loss from pooled separate accounts	2017-12-31	$369,885
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
Contributions received in cash from employer	2017-12-31	$128,515
Employer contributions (assets) at beginning of year	2017-12-31	$50
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$79,526
Contract administrator fees	2017-12-31	$1,429
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	ROORDA, PIQUET & BESSEE INC.
Accountancy firm EIN	2017-12-31	330252865

Form 5500 Responses for RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST

2023: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: RC JENSON INC 401(K) PROFIT SHARING PLAN AND TRUST 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

23508

Policy instance

Insurance contract or identification number	23508
Number of Individuals Covered	121
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,947
Total amount of fees paid to insurance company	USD $3,932
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

23508

Policy instance

Insurance contract or identification number	23508
Number of Individuals Covered	122
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $12,034
Total amount of fees paid to insurance company	USD $5,034
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,034
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	4

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

Policy contract number

23508

Policy instance

Insurance contract or identification number	23508
Number of Individuals Covered	136
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,604
Total amount of fees paid to insurance company	USD $2,523
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $12,604
Insurance broker organization code?	4
Amount paid for insurance broker fees	2523
Additional information about fees paid to insurance broker	JOHN HANCOCK PROGRAM CONTRACT PERSISTENCY

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

Policy contract number

23508

Policy instance

Insurance contract or identification number	23508
Number of Individuals Covered	110
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,657
Total amount of fees paid to insurance company	USD $1,733
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $8,657
Insurance broker organization code?	4
Amount paid for insurance broker fees	1733
Additional information about fees paid to insurance broker	JOHN HANCOCK PROGRAM CONTRACT PERSISTENCY

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

Policy contract number

23508

Policy instance

Insurance contract or identification number	23508
Number of Individuals Covered	90
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 $1,528
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Amount paid for insurance broker fees	1528
Insurance broker organization code?	4

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

Policy contract number

Policy instance

Number of Individuals Covered	102
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,602
Total amount of fees paid to insurance company	USD $1,470
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $7,602
Insurance broker organization code?	4
Amount paid for insurance broker fees	1470
Additional information about fees paid to insurance broker	JOHN HANCOCK PROGRAM CONTRACT PERSISTENCY

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

Policy contract number

Policy instance

Number of Individuals Covered	99
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,961
Total amount of fees paid to insurance company	USD $1,247
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $8,961
Insurance broker organization code?	4
Amount paid for insurance broker fees	1247
Additional information about fees paid to insurance broker	JOHN HANCOCK PROGRAM CONTRACT PERSISTENCY
Insurance broker name	DISSINGER ASSOCIATES

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Company Name:	RC JENSON INC DBA JENSON USA
Employer identification number (EIN):	330792981
NAIC Classification:	451110
NAIC Description:	Sporting Goods Stores