401k Plan data: LEES MARKETPLACE, INC. PROFIT SHARING TRUST plan

LEES MARKETPLACE, INC. PROFIT SHARING TRUST 401k Plan overview

Plan Name	LEES MARKETPLACE, INC. PROFIT SHARING TRUST
Plan identification number	004

LEES MARKETPLACE, INC. PROFIT SHARING TRUST Benefits

No plan benefit data available

401k Sponsoring company profile

LEES MARKETPLACE, INC. has sponsored the creation of one or more 401k plans.

Company Name: LEES MARKETPLACE, INC.

Employer identification number (EIN): 870372019

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEES MARKETPLACE, INC. PROFIT SHARING TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2015-01-01 JONATHAN BADGER JONATHAN BADGER 2016-09-16
004 2015-01-01 JONATHAN BADGER 2018-12-31
004 2014-01-01 2016-12-12
004 2013-01-01 JONATHAN BADGER JONATHAN BADGER 2014-08-06
004 2012-01-01 2013-07-31
004 2011-01-01 SHARI L. BADGER
004 2009-12-01 2010-09-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
004	2015-01-01	JONATHAN BADGER		JONATHAN BADGER	2016-09-16
004	2015-01-01			JONATHAN BADGER	2018-12-31
004	2014-01-01		2016-12-12
004	2013-01-01	JONATHAN BADGER		JONATHAN BADGER	2014-08-06
004	2012-01-01		2013-07-31
004	2011-01-01	SHARI L. BADGER
004	2009-12-01		2010-09-21

Financial Data on LEES MARKETPLACE, INC. PROFIT SHARING TRUST

Measure	Date	Value
2015 : LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$358,370
Total transfer of assets from this plan	2015-12-31	$224,945
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	$-53,298
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$23,094
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$2,739,818
Value of total assets at beginning of year	2015-12-31	$2,682,785
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$23,094
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Administrative expenses professional fees incurred	2015-12-31	$23,094
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Total non interest bearing cash at end of year	2015-12-31	$698
Total non interest bearing cash at beginning of year	2015-12-31	$3,695
Value of net income/loss	2015-12-31	$-76,392
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,739,818
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,682,785
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 master investment trust accounts at end of year	2015-12-31	$2,739,120
Value of interest in master investment trust accounts at beginning of year	2015-12-31	$2,678,740
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$350
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$350
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	Yes
2014 : LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$348,540
Total transfer of assets from this plan	2014-12-31	$127,528
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	$116,979
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$14,421
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$2,682,785
Value of total assets at beginning of year	2014-12-31	$2,359,215
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$14,421
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Administrative expenses professional fees incurred	2014-12-31	$1,200
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Total non interest bearing cash at end of year	2014-12-31	$3,695
Total non interest bearing cash at beginning of year	2014-12-31	$2,215
Value of net income/loss	2014-12-31	$102,558
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,682,785
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,359,215
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 master investment trust accounts at end of year	2014-12-31	$2,678,740
Value of interest in master investment trust accounts at beginning of year	2014-12-31	$2,356,748
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$350
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$252
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$252
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Contract administrator fees	2014-12-31	$13,221
Did the plan have assets held for investment	2014-12-31	Yes
2013 : LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	2013-12-31	$350,838
Total transfer of assets from this plan	2013-12-31	$64,246
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	$380,345
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$14,100
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$2,359,215
Value of total assets at beginning of year	2013-12-31	$1,706,378
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$14,100
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Administrative expenses professional fees incurred	2013-12-31	$14,100
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Total non interest bearing cash at end of year	2013-12-31	$2,215
Total non interest bearing cash at beginning of year	2013-12-31	$5,815
Value of net income/loss	2013-12-31	$366,245
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,359,215
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,706,378
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 master investment trust accounts at end of year	2013-12-31	$2,356,748
Value of interest in master investment trust accounts at beginning of year	2013-12-31	$1,700,404
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$252
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$159
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$159
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	Yes
2012 : LEES MARKETPLACE, INC. PROFIT SHARING TRUST 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	$198,936
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$12,421
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$1,706,378
Value of total assets at beginning of year	2012-12-31	$1,265,813
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$12,421
Total interest from all sources	2012-12-31	$35
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Administrative expenses professional fees incurred	2012-12-31	$625
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Total non interest bearing cash at end of year	2012-12-31	$5,815
Total non interest bearing cash at beginning of year	2012-12-31	$6,598
Value of net income/loss	2012-12-31	$186,515
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,706,378
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,265,813
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 master investment trust accounts at end of year	2012-12-31	$1,700,404
Value of interest in master investment trust accounts at beginning of year	2012-12-31	$1,254,421
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$159
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$4,794
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$4,794
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$35
Net investment gain/loss from pooled separate accounts	2012-12-31	$198,901
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Contract administrator fees	2012-12-31	$11,796
Did the plan have assets held for investment	2012-12-31	Yes
2011 : LEES MARKETPLACE, INC. PROFIT SHARING TRUST 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	$0
Total income from all sources (including contributions)	2011-12-31	$-54,684
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$12,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$1,265,813
Value of total assets at beginning of year	2011-12-31	$1,212,066
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$12,930
Total interest from all sources	2011-12-31	$16
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Administrative expenses professional fees incurred	2011-12-31	$600
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Total non interest bearing cash at end of year	2011-12-31	$6,598
Total non interest bearing cash at beginning of year	2011-12-31	$2,565
Value of net income/loss	2011-12-31	$-67,614
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,265,813
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,212,066
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 master investment trust accounts at end of year	2011-12-31	$1,254,421
Value of interest in master investment trust accounts at beginning of year	2011-12-31	$1,209,501
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$4,794
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$16
Net investment gain/loss from pooled separate accounts	2011-12-31	$-54,700
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Contract administrator fees	2011-12-31	$12,330
Did the plan have assets held for investment	2011-12-31	Yes
2010 : LEES MARKETPLACE, INC. PROFIT SHARING TRUST 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	$0
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	$143,459
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$12,752
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$1,212,066
Value of total assets at beginning of year	2010-12-31	$962,033
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$12,752
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Administrative expenses professional fees incurred	2010-12-31	$750
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Total non interest bearing cash at end of year	2010-12-31	$2,565
Value of net income/loss	2010-12-31	$130,707
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,212,066
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$962,033
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 master investment trust accounts at end of year	2010-12-31	$1,209,501
Value of interest in master investment trust accounts at beginning of year	2010-12-31	$956,080
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$5,953
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$5,953
Net investment gain/loss from pooled separate accounts	2010-12-31	$143,459
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Contract administrator fees	2010-12-31	$12,002
Did the plan have assets held for investment	2010-12-31	Yes

Form 5500 Responses for LEES MARKETPLACE, INC. PROFIT SHARING TRUST

2015: LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	DFE (Diect Filing Entity)
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
2014: LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	DFE (Diect Filing Entity)
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
2013: LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	DFE (Diect Filing Entity)
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
2012: LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	DFE (Diect Filing Entity)
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
2011: LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	DFE (Diect Filing Entity)
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
2009: LEES MARKETPLACE, INC. PROFIT SHARING TRUST 2009 form 5500 responses
2009-12-01	Type of plan entity	DFE (Diect Filing Entity)
2009-12-01	First time form 5500 has been submitted	Yes
2009-12-01	Submission has been amended	No
2009-12-01	This submission is the final filing	No
2009-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-12-01	Plan is a collectively bargained plan	No
2009-12-01	Plan funding arrangement – Trust	Yes
2009-12-01	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

29950

Policy instance

Insurance contract or identification number	29950
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,781
Total amount of fees paid to insurance company	USD $23,902
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $1,781
Insurance broker organization code?	4
Amount paid for insurance broker fees	17684
Additional information about fees paid to insurance broker	MANAGEMENT FEES
Insurance broker name	NATIONAL BENEFIT SERVICES, LLC

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

Policy contract number

29950

Policy instance

Insurance contract or identification number	29950
Number of Individuals Covered	112
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,299
Total amount of fees paid to insurance company	USD $1,200
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?	Yes
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 $10,016
Insurance broker organization code?	4
Amount paid for insurance broker fees	1200
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	NATIONAL BENEFIT SERVICES, LLC

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

Policy contract number

29950

Policy instance

Insurance contract or identification number	29950
Number of Individuals Covered	115
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,981
Total amount of fees paid to insurance company	USD $5,119
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $6,202
Insurance broker organization code?	4
Amount paid for insurance broker fees	5119
Additional information about fees paid to insurance broker	TPA FEES TPA COMPENSATION
Insurance broker name	WOODBURY FINANCIAL SERVICES

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

Policy contract number

29950

Policy instance

Insurance contract or identification number	29950
Number of Individuals Covered	104
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,819
Total amount of fees paid to insurance company	USD $5,613
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?	Yes
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 $803
Amount paid for insurance broker fees	5613
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	WOODBURY FINANCIAL SERVICES

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

Policy contract number

29950

Policy instance

Insurance contract or identification number	29950
Number of Individuals Covered	106
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,565
Total amount of fees paid to insurance company	USD $600
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?	Yes
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

29950

Policy instance

Insurance contract or identification number	29950
Number of Individuals Covered	92
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,490
Total amount of fees paid to insurance company	USD $4,138
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 $505
Amount paid for insurance broker fees	4138
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	INSPHERE SECURITIES, INC.

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Company Name:	LEES MARKETPLACE, INC.
Employer identification number (EIN):	870372019
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores