401k Plan data: ICMS & IPS RETIREMENT PLAN plan

ICMS & IPS RETIREMENT PLAN 401k Plan overview

Plan Name	ICMS & IPS RETIREMENT PLAN
Plan identification number	001

ICMS & IPS RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
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

INGERSOLL CM SYSTEMS, LLC has sponsored the creation of one or more 401k plans.

Company Name: INGERSOLL CM SYSTEMS, LLC

Employer identification number (EIN): 810620260

NAIC Classification: 333510

Additional information about INGERSOLL CM SYSTEMS, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3676636

More information about INGERSOLL CM SYSTEMS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ICMS & IPS RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01 BRIANA RUTKIEWICZ 2022-05-18
001 2020-01-01 BRIANA RUTKIEWICZ 2021-07-27
001 2019-01-01 BRIANA RUTKIEWICZ 2020-07-28
001 2018-01-01 BRIANA RUTKIEWICZ 2019-07-15
001 2017-01-01 BRIANA RUTKIEWICZ 2018-07-23
001 2016-01-01 BRIANA RUTKIEWICZ
001 2015-01-01 BRIANA RUTKIEWICZ
001 2014-01-01 LEEANNE RICE
001 2013-01-01 LEEANNE RICE
001 2012-01-01 BRIANA RUTKIEWICZ
001 2011-01-01 BRIANA RUTKIEWICZ
001 2010-01-01 BRIANA RUTKIEWICZ

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01	BRIANA RUTKIEWICZ	2022-05-18
001	2020-01-01	BRIANA RUTKIEWICZ	2021-07-27
001	2019-01-01	BRIANA RUTKIEWICZ	2020-07-28
001	2018-01-01	BRIANA RUTKIEWICZ	2019-07-15
001	2017-01-01	BRIANA RUTKIEWICZ	2018-07-23
001	2016-01-01	BRIANA RUTKIEWICZ
001	2015-01-01	BRIANA RUTKIEWICZ
001	2014-01-01	LEEANNE RICE
001	2013-01-01	LEEANNE RICE
001	2012-01-01	BRIANA RUTKIEWICZ
001	2011-01-01	BRIANA RUTKIEWICZ
001	2010-01-01	BRIANA RUTKIEWICZ

Plan Statistics for ICMS & IPS RETIREMENT PLAN

401k plan membership statisitcs for ICMS & IPS RETIREMENT PLAN

Measure Date Value
2016: ICMS & IPS RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 72
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 24
Total of all active and inactive participants 2016-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 96
Number of participants with account balances 2016-01-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 1
2015: ICMS & IPS RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 76
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 21
Total of all active and inactive participants 2015-01-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 97
Number of participants with account balances 2015-01-01 75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 2
2014: ICMS & IPS RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 78
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 21
Total of all active and inactive participants 2014-01-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 99
Number of participants with account balances 2014-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: ICMS & IPS RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 93
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 18
Total of all active and inactive participants 2013-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 111
Number of participants with account balances 2013-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: ICMS & IPS RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 107
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 15
Total of all active and inactive participants 2012-01-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 122
Number of participants with account balances 2012-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: ICMS & IPS RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 110
Number of other retired or separated participants entitled to future benefits 2011-01-01 17
Total of all active and inactive participants 2011-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 127
Number of participants with account balances 2011-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: ICMS & IPS RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 94
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 11
Total of all active and inactive participants 2010-01-01 105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 105
Number of participants with account balances 2010-01-01 80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 2

Measure	Date	Value
2016: ICMS & IPS RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	72
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	24
Total of all active and inactive participants	2016-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	96
Number of participants with account balances	2016-01-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1
2015: ICMS & IPS RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	76
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	21
Total of all active and inactive participants	2015-01-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	97
Number of participants with account balances	2015-01-01	75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	2
2014: ICMS & IPS RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	78
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	21
Total of all active and inactive participants	2014-01-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	99
Number of participants with account balances	2014-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: ICMS & IPS RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	93
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	18
Total of all active and inactive participants	2013-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	111
Number of participants with account balances	2013-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: ICMS & IPS RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	107
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	15
Total of all active and inactive participants	2012-01-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	122
Number of participants with account balances	2012-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: ICMS & IPS RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	110
Number of other retired or separated participants entitled to future benefits	2011-01-01	17
Total of all active and inactive participants	2011-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	127
Number of participants with account balances	2011-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: ICMS & IPS RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	94
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	11
Total of all active and inactive participants	2010-01-01	105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	105
Number of participants with account balances	2010-01-01	80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	2

Financial Data on ICMS & IPS RETIREMENT PLAN

Measure	Date	Value
2016 : ICMS & IPS RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$943,615
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$387,217
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$346,952
Expenses. Certain deemed distributions of participant loans	2016-12-31	$39,783
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$352,272
Value of total assets at end of year	2016-12-31	$6,713,704
Value of total assets at beginning of year	2016-12-31	$6,157,306
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$482
Total interest from all sources	2016-12-31	$5,754
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$150
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$299,838
Participant contributions at end of year	2016-12-31	$104,086
Participant contributions at beginning of year	2016-12-31	$161,220
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$556,398
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$6,713,704
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$6,157,306
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$6,280,180
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$5,674,347
Interest on participant loans	2016-12-31	$5,754
Value of interest in common/collective trusts at end of year	2016-12-31	$329,438
Value of interest in common/collective trusts at beginning of year	2016-12-31	$321,739
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$585,589
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$52,434
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$346,952
Contract administrator fees	2016-12-31	$332
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	SIKICH LLP
Accountancy firm EIN	2016-12-31	363168081
2015 : ICMS & IPS RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$221,964
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$603,823
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$603,467
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$280,446
Value of total assets at end of year	2015-12-31	$6,157,306
Value of total assets at beginning of year	2015-12-31	$6,539,165
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$356
Total interest from all sources	2015-12-31	$6,214
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$280,446
Participant contributions at end of year	2015-12-31	$161,220
Participant contributions at beginning of year	2015-12-31	$127,369
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-381,859
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$6,157,306
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$6,539,165
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$5,674,347
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$6,105,317
Interest on participant loans	2015-12-31	$6,214
Value of interest in common/collective trusts at end of year	2015-12-31	$321,739
Value of interest in common/collective trusts at beginning of year	2015-12-31	$306,479
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-64,696
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$603,467
Contract administrator fees	2015-12-31	$356
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	SIKICH LLP
Accountancy firm EIN	2015-12-31	363168081
2014 : ICMS & IPS RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$672,412
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$737,704
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$737,107
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$278,260
Value of total assets at end of year	2014-12-31	$6,539,165
Value of total assets at beginning of year	2014-12-31	$6,604,457
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$597
Total interest from all sources	2014-12-31	$5,620
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$278,260
Participant contributions at end of year	2014-12-31	$127,369
Participant contributions at beginning of year	2014-12-31	$129,328
Administrative expenses (other) incurred	2014-12-31	$225
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-65,292
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$6,539,165
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$6,604,457
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$6,105,317
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$6,197,636
Interest on participant loans	2014-12-31	$5,620
Value of interest in common/collective trusts at end of year	2014-12-31	$306,479
Value of interest in common/collective trusts at beginning of year	2014-12-31	$277,493
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$388,532
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$737,107
Contract administrator fees	2014-12-31	$372
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	SIKICH LLP
Accountancy firm EIN	2014-12-31	363168081
2013 : ICMS & IPS RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$1,561,464
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$529,591
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$528,869
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$380,678
Value of total assets at end of year	2013-12-31	$6,604,457
Value of total assets at beginning of year	2013-12-31	$5,572,584
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$722
Total interest from all sources	2013-12-31	$3,986
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$324,568
Participant contributions at end of year	2013-12-31	$129,328
Participant contributions at beginning of year	2013-12-31	$72,788
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$56,110
Administrative expenses (other) incurred	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$1,031,873
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$6,604,457
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$5,572,584
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$6,197,636
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$5,249,052
Interest on participant loans	2013-12-31	$3,986
Value of interest in common/collective trusts at end of year	2013-12-31	$277,493
Value of interest in common/collective trusts at beginning of year	2013-12-31	$250,744
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,176,800
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$528,869
Contract administrator fees	2013-12-31	$422
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	SIKICH LLP
Accountancy firm EIN	2013-12-31	363168081
2012 : ICMS & IPS RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$1,072,481
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$339,503
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$339,074
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$400,655
Value of total assets at end of year	2012-12-31	$5,572,584
Value of total assets at beginning of year	2012-12-31	$4,839,606
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$429
Total interest from all sources	2012-12-31	$3,284
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$400,520
Participant contributions at end of year	2012-12-31	$72,788
Participant contributions at beginning of year	2012-12-31	$76,521
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$135
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$732,978
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$5,572,584
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$4,839,606
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$5,249,052
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$4,541,145
Interest on participant loans	2012-12-31	$3,284
Value of interest in common/collective trusts at end of year	2012-12-31	$250,744
Value of interest in common/collective trusts at beginning of year	2012-12-31	$221,940
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$668,542
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$339,074
Contract administrator fees	2012-12-31	$429
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	SIKICH LLP
Accountancy firm EIN	2012-12-31	363168081
2011 : ICMS & IPS RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$11,407
Total income from all sources (including contributions)	2011-12-31	$451,919
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$185,052
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$182,516
Expenses. Certain deemed distributions of participant loans	2011-12-31	$2,133
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$511,961
Value of total assets at end of year	2011-12-31	$4,839,606
Value of total assets at beginning of year	2011-12-31	$4,584,146
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$403
Total interest from all sources	2011-12-31	$4,523
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$438,416
Participant contributions at end of year	2011-12-31	$76,521
Participant contributions at beginning of year	2011-12-31	$115,750
Participant contributions at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$73,545
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$11,407
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$266,867
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$4,839,606
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$4,572,739
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$0
Value of interest in pooled separate accounts at end of year	2011-12-31	$4,541,145
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$4,277,235
Interest on participant loans	2011-12-31	$4,523
Value of interest in common/collective trusts at end of year	2011-12-31	$221,940
Value of interest in common/collective trusts at beginning of year	2011-12-31	$191,161
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-64,565
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$182,516
Contract administrator fees	2011-12-31	$403
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	SIKICH LLP
Accountancy firm EIN	2011-12-31	363168081
2010 : ICMS & IPS RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$11,407
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$887,637
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,486,598
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,448,141
Value of total corrective distributions	2010-12-31	$32,405
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$345,895
Value of total assets at end of year	2010-12-31	$4,584,146
Value of total assets at beginning of year	2010-12-31	$5,171,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$6,052
Total interest from all sources	2010-12-31	$7,331
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$8,124
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$8,124
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$345,895
Participant contributions at end of year	2010-12-31	$115,750
Participant contributions at beginning of year	2010-12-31	$191,063
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$13,330
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$11,407
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-598,961
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$4,572,739
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$5,171,700
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$4,424,134
Value of interest in pooled separate accounts at end of year	2010-12-31	$4,277,235
Interest on participant loans	2010-12-31	$7,331
Value of interest in common/collective trusts at end of year	2010-12-31	$191,161
Value of interest in common/collective trusts at beginning of year	2010-12-31	$543,173
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$526,287
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,448,141
Contract administrator fees	2010-12-31	$6,052
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	2010-12-31	Yes
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	SIKICH LLP
Accountancy firm EIN	2010-12-31	363168081

Form 5500 Responses for ICMS & IPS RETIREMENT PLAN

2016: ICMS & IPS RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ICMS & IPS RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ICMS & IPS RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ICMS & IPS RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: ICMS & IPS RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: ICMS & IPS RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: ICMS & IPS RETIREMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	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

96375

Policy instance

Insurance contract or identification number	96375
Number of Individuals Covered	76
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $12,549
Total amount of fees paid to insurance company	USD $3,182
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,549
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	4
Amount paid for insurance broker fees	3182
Insurance broker name	WATKINS, ROSS & CO

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

Policy contract number

96375

Policy instance

Insurance contract or identification number	96375
Number of Individuals Covered	79
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $13,092
Total amount of fees paid to insurance company	USD $3,551
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,092
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	4
Amount paid for insurance broker fees	3551
Insurance broker name	WATKINS, ROSS & CO

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

Policy contract number

96375

Policy instance

Insurance contract or identification number	96375
Number of Individuals Covered	90
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $12,335
Total amount of fees paid to insurance company	USD $3,424
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,335
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	4
Amount paid for insurance broker fees	3424
Insurance broker name	WATKINS, ROSS & CO

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

Policy contract number

96375

Policy instance

Insurance contract or identification number	96375
Number of Individuals Covered	97
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $15,304
Total amount of fees paid to insurance company	USD $2,633
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,304
Insurance broker organization code?	4
Amount paid for insurance broker fees	2633
Additional information about fees paid to insurance broker	TPA SERVICES
Insurance broker name	WATKINS, ROSS & CO

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

Policy contract number

96375

Policy instance

Insurance contract or identification number	96375
Number of Individuals Covered	95
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,746
Total amount of fees paid to insurance company	USD $3,190
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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

Policy contract number

96375

Policy instance

Insurance contract or identification number	96375
Number of Individuals Covered	83
Insurance policy start date	2010-03-15
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $20,044
Total amount of fees paid to insurance company	USD $11,526
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $20,044
Insurance broker organization code?	4
Amount paid for insurance broker fees	11526
Additional information about fees paid to insurance broker	TPA SERVICES
Insurance broker name	WATKINS, ROSS & CO

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Company Name:	INGERSOLL CM SYSTEMS, LLC
Employer identification number (EIN):	810620260
NAIC Classification:	333510

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3676636