401k Plan data: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST plan

UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 401k Plan overview

Plan Name	UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST
Plan identification number	003

UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

UPCHURCH MANAGEMENT COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: UPCHURCH MANAGEMENT COMPANY, INC.

Employer identification number (EIN): 592057671

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2023-01-01 MARY GRIESEMER 2024-10-07
003 2022-01-01 MARY GRIESEMER 2023-10-02
003 2021-01-01 MARY GRIESEMER 2022-10-05
003 2020-01-01 MARY GRIESEMER 2021-10-14
003 2019-01-01 MARY GRIESEMER 2020-10-13
003 2018-01-01 MARY GRIESEMER 2019-10-14
003 2017-01-01
003 2016-01-01
003 2015-01-01 MARY GRIESEMER 2016-10-14
003 2013-01-01 MARY GRIESEMER 2014-07-11
003 2011-01-01 MARY GRIESEMER 2012-07-05
003 2010-01-01 MARY GRIESEMER 2011-07-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
003	2023-01-01	MARY GRIESEMER	2024-10-07
003	2022-01-01	MARY GRIESEMER	2023-10-02
003	2021-01-01	MARY GRIESEMER	2022-10-05
003	2020-01-01	MARY GRIESEMER	2021-10-14
003	2019-01-01	MARY GRIESEMER	2020-10-13
003	2018-01-01	MARY GRIESEMER	2019-10-14
003	2017-01-01
003	2016-01-01
003	2015-01-01	MARY GRIESEMER	2016-10-14
003	2013-01-01	MARY GRIESEMER	2014-07-11
003	2011-01-01	MARY GRIESEMER	2012-07-05
003	2010-01-01	MARY GRIESEMER	2011-07-08

Plan Statistics for UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST

401k plan membership statisitcs for UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST

Measure Date Value
2023: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2023 401k membership
Total participants, beginning-of-year 2023-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 130
Number of retired or separated participants receiving benefits 2023-01-01 6
Number of other retired or separated participants entitled to future benefits 2023-01-01 14
Total of all active and inactive participants 2023-01-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 150
Number of participants with account balances 2023-01-01 134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 0
2022: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2022 401k membership
Total participants, beginning-of-year 2022-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 135
Number of retired or separated participants receiving benefits 2022-01-01 4
Number of other retired or separated participants entitled to future benefits 2022-01-01 13
Total of all active and inactive participants 2022-01-01 152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 152
Number of participants with account balances 2022-01-01 130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 10
2021: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2021 401k membership
Total participants, beginning-of-year 2021-01-01 681
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 134
Number of retired or separated participants receiving benefits 2021-01-01 4
Number of other retired or separated participants entitled to future benefits 2021-01-01 12
Total of all active and inactive participants 2021-01-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 150
Number of participants with account balances 2021-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2020 401k membership
Total participants, beginning-of-year 2020-01-01 644
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 668
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 13
Total of all active and inactive participants 2020-01-01 683
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 683
Number of participants with account balances 2020-01-01 124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 1
2019: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2019 401k membership
Total participants, beginning-of-year 2019-01-01 408
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 541
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 10
Total of all active and inactive participants 2019-01-01 552
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 552
Number of participants with account balances 2019-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2018 401k membership
Total participants, beginning-of-year 2018-01-01 377
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 387
Number of retired or separated participants receiving benefits 2018-01-01 2
Number of other retired or separated participants entitled to future benefits 2018-01-01 19
Total of all active and inactive participants 2018-01-01 408
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 408
Number of participants with account balances 2018-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 3
2017: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2017 401k membership
Total participants, beginning-of-year 2017-01-01 229
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 308
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 14
Total of all active and inactive participants 2017-01-01 323
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 323
Number of participants with account balances 2017-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2

Measure	Date	Value
2023: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2023 401k membership
Total participants, beginning-of-year	2023-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	130
Number of retired or separated participants receiving benefits	2023-01-01	6
Number of other retired or separated participants entitled to future benefits	2023-01-01	14
Total of all active and inactive participants	2023-01-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	150
Number of participants with account balances	2023-01-01	134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	0
2022: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2022 401k membership
Total participants, beginning-of-year	2022-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	135
Number of retired or separated participants receiving benefits	2022-01-01	4
Number of other retired or separated participants entitled to future benefits	2022-01-01	13
Total of all active and inactive participants	2022-01-01	152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	152
Number of participants with account balances	2022-01-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	10
2021: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2021 401k membership
Total participants, beginning-of-year	2021-01-01	681
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	134
Number of retired or separated participants receiving benefits	2021-01-01	4
Number of other retired or separated participants entitled to future benefits	2021-01-01	12
Total of all active and inactive participants	2021-01-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	150
Number of participants with account balances	2021-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2020 401k membership
Total participants, beginning-of-year	2020-01-01	644
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	668
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	13
Total of all active and inactive participants	2020-01-01	683
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	683
Number of participants with account balances	2020-01-01	124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	1
2019: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	408
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	541
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	10
Total of all active and inactive participants	2019-01-01	552
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	552
Number of participants with account balances	2019-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	377
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	387
Number of retired or separated participants receiving benefits	2018-01-01	2
Number of other retired or separated participants entitled to future benefits	2018-01-01	19
Total of all active and inactive participants	2018-01-01	408
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	408
Number of participants with account balances	2018-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	3
2017: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	229
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	308
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	14
Total of all active and inactive participants	2017-01-01	323
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	323
Number of participants with account balances	2017-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2

Financial Data on UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST

Measure	Date	Value
2023 : UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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	$0
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	$1,182,278
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$435,966
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$399,351
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$576,266
Value of total assets at end of year	2023-12-31	$5,165,791
Value of total assets at beginning of year	2023-12-31	$4,419,479
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$36,615
Total interest from all sources	2023-12-31	$0
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	$420,741
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2023-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2023-12-31	$0
Total non interest bearing cash at end of year	2023-12-31	$13,136
Total non interest bearing cash at beginning of year	2023-12-31	$8,300
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	$746,312
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$5,165,791
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$4,419,479
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	$5,152,655
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$4,411,179
Net investment gain or loss from common/collective trusts	2023-12-31	$606,012
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	$155,525
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$399,351
Contract administrator fees	2023-12-31	$475
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	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2023-12-31	410746749
2022 : UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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	$-334,224
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$451,551
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$413,139
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$561,801
Value of total assets at end of year	2022-12-31	$4,419,479
Value of total assets at beginning of year	2022-12-31	$5,205,254
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$38,412
Total interest from all sources	2022-12-31	$0
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	$24,100
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	$400,807
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$16,171
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$8,300
Total non interest bearing cash at beginning of year	2022-12-31	$4,970
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	$-785,775
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,419,479
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,205,254
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	$13,762
Value of interest in pooled separate accounts at end of year	2022-12-31	$4,411,179
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$5,200,284
Net investment gain or loss from common/collective trusts	2022-12-31	$-896,025
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	$144,823
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$413,139
Contract administrator fees	2022-12-31	$550
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	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2022-12-31	410746749
2021 : UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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	$61
Total income from all sources (including contributions)	2021-12-31	$1,065,697
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$523,287
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$483,125
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$523,018
Value of total assets at end of year	2021-12-31	$5,205,254
Value of total assets at beginning of year	2021-12-31	$4,662,905
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$40,162
Total interest from all sources	2021-12-31	$0
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
Administrative expenses professional fees incurred	2021-12-31	$25,262
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	$390,311
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$61
Total non interest bearing cash at end of year	2021-12-31	$4,970
Total non interest bearing cash at beginning of year	2021-12-31	$2,632
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	$542,410
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,205,254
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,662,844
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	$14,550
Value of interest in pooled separate accounts at end of year	2021-12-31	$5,200,284
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$4,660,273
Net investment gain or loss from common/collective trusts	2021-12-31	$542,679
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	$132,707
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$483,125
Contract administrator fees	2021-12-31	$350
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	CONCANNON, MILLER AND CO, P.C.
Accountancy firm EIN	2021-12-31	232620120
2020 : UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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	$61
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	$1,015,720
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$217,205
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$183,087
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$400,357
Value of total assets at end of year	2020-12-31	$4,662,905
Value of total assets at beginning of year	2020-12-31	$3,864,329
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$34,118
Total interest from all sources	2020-12-31	$0
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
Administrative expenses professional fees incurred	2020-12-31	$21,689
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$275,000
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	$300,198
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$61
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$2,632
Total non interest bearing cash at beginning of year	2020-12-31	$2,971
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	$798,515
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,662,844
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,864,329
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	$12,104
Value of interest in pooled separate accounts at end of year	2020-12-31	$4,660,273
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$3,861,358
Net investment gain/loss from pooled separate accounts	2020-12-31	$615,363
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	$100,159
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$183,087
Contract administrator fees	2020-12-31	$325
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	CONCANNON, MILLER AND CO, P.C.
Accountancy firm EIN	2020-12-31	232620120
2019 : UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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	$1,032,085
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$363,788
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$344,025
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$409,249
Value of total assets at end of year	2019-12-31	$3,864,329
Value of total assets at beginning of year	2019-12-31	$3,196,032
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$19,763
Total interest from all sources	2019-12-31	$0
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
Administrative expenses professional fees incurred	2019-12-31	$12,637
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$275,000
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	$277,773
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$43,265
Other income not declared elsewhere	2019-12-31	$1,459
Total non interest bearing cash at end of year	2019-12-31	$2,971
Total non interest bearing cash at beginning of year	2019-12-31	$813
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	$668,297
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,864,329
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,196,032
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	$6,526
Value of interest in pooled separate accounts at end of year	2019-12-31	$3,861,358
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$3,195,219
Net investment gain/loss from pooled separate accounts	2019-12-31	$621,377
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	$88,211
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$344,025
Contract administrator fees	2019-12-31	$600
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	CONCANNON, MILLER AND CO, P.C.
Accountancy firm EIN	2019-12-31	232620120
2018 : UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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	$119,140
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$148,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$147,356
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$312,390
Value of total assets at end of year	2018-12-31	$3,196,032
Value of total assets at beginning of year	2018-12-31	$3,224,998
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$750
Total interest from all sources	2018-12-31	$0
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
Administrative expenses professional fees incurred	2018-12-31	$350
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$275,000
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	$233,623
Other income not declared elsewhere	2018-12-31	$3,301
Total non interest bearing cash at end of year	2018-12-31	$813
Total non interest bearing cash at beginning of year	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	$-28,966
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,196,032
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,224,998
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 pooled separate accounts at end of year	2018-12-31	$3,195,219
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$3,224,998
Net investment gain/loss from pooled separate accounts	2018-12-31	$-196,551
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	$78,767
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$147,356
Contract administrator fees	2018-12-31	$400
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
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	CONCANNON, MILLER AND CO, P.C.
Accountancy firm EIN	2018-12-31	232620120
2017 : UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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	$658,549
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$109,377
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$108,777
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$262,194
Value of total assets at end of year	2017-12-31	$3,224,998
Value of total assets at beginning of year	2017-12-31	$2,675,826
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$600
Total interest from all sources	2017-12-31	$0
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
Administrative expenses professional fees incurred	2017-12-31	$275
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$275,000
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	$192,879
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$2,971
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	$549,172
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,224,998
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,675,826
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 pooled separate accounts at end of year	2017-12-31	$3,224,998
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,675,826
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$393,384
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	$69,315
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$108,777
Contract administrator fees	2017-12-31	$325
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
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	CONCANNON, MILLER AND CO, P.C.
Accountancy firm EIN	2017-12-31	232620120

Form 5500 Responses for UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST

2023: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING TRUST 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
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: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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 funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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 funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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 funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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 funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: UPCHURCH MANAGEMENT CO., INC. EMPLOYEES SAVING 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 funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

117117

Policy instance

Insurance contract or identification number	117117
Number of Individuals Covered	148
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $475
Total amount of fees paid to insurance company	USD $2,396
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

117117

Policy instance

Insurance contract or identification number	117117
Number of Individuals Covered	147
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $550
Total amount of fees paid to insurance company	USD $2,330
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2330
Additional information about fees paid to insurance broker	CONTRACT MANAGEMENT ASSISTANCE
Insurance broker organization code?	0
Commission paid to Insurance Broker	USD $550

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

Policy contract number

117117

Policy instance

Insurance contract or identification number	117117
Number of Individuals Covered	140
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $350
Total amount of fees paid to insurance company	USD $2,406
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	2406
Additional information about fees paid to insurance broker	CONTRACT MANAGEMENT ASSISTANCE
Insurance broker organization code?	0

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

Policy contract number

117117

Policy instance

Insurance contract or identification number	117117
Number of Individuals Covered	127
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $325
Total amount of fees paid to insurance company	USD $1,986
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1986
Additional information about fees paid to insurance broker	CONTRACT MANAGEMENT ASSISTANCE
Insurance broker organization code?	0
Commission paid to Insurance Broker	USD $325

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

Policy contract number

117117

Policy instance

Insurance contract or identification number	117117
Number of Individuals Covered	108
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,987
Total amount of fees paid to insurance company	USD $1,790
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,061
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

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

Policy contract number

117117

Policy instance

Insurance contract or identification number	117117
Number of Individuals Covered	100
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $11,122
Total amount of fees paid to insurance company	USD $2,052
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1652
Additional information about fees paid to insurance broker	CONTRACT MANAGEMENT ASSISTANCE
Insurance broker organization code?	0
Commission paid to Insurance Broker	USD $9,808

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

Policy contract number

117117

Policy instance

Insurance contract or identification number	117117
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 $9,748
Total amount of fees paid to insurance company	USD $1,789
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,614
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	EJREYNOLDS, INC.

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Company Name:	UPCHURCH MANAGEMENT COMPANY, INC.
Employer identification number (EIN):	592057671
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants