401k Plan data: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST plan

OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

OCURRANCE INC has sponsored the creation of one or more 401k plans.

Company Name: OCURRANCE INC

Employer identification number (EIN): 870524420

NAIC Classification: 561420

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 ASAMANJA CHATTERJEE 2019-10-03
001 2015-01-01 ASAMANJA CHATTERJEE
001 2014-01-01 JANELL GREENWOOD
001 2013-01-01 JANELL GREENWOOD
001 2012-01-01 JANELL GREENWOOD
001 2011-01-01 TOM CANNON
001 2010-01-01 SEAN ESTES SEAN ESTES 2011-10-17
001 2009-01-01 SEAN ESTES SEAN ESTES 2010-10-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	ASAMANJA CHATTERJEE	2019-10-03
001	2015-01-01	ASAMANJA CHATTERJEE
001	2014-01-01	JANELL GREENWOOD
001	2013-01-01	JANELL GREENWOOD
001	2012-01-01	JANELL GREENWOOD
001	2011-01-01	TOM CANNON
001	2010-01-01	SEAN ESTES		SEAN ESTES	2011-10-17
001	2009-01-01	SEAN ESTES		SEAN ESTES	2010-10-06

Plan Statistics for OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2015: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 99
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 66
Total of all active and inactive participants 2015-01-01 165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 165
Number of participants with account balances 2015-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 165
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 0
Total of all active and inactive participants 2014-01-01 165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 165
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 512
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 88
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 52
Total of all active and inactive participants 2013-01-01 140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 140
Number of participants with account balances 2013-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 309
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 370
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 42
Total of all active and inactive participants 2012-01-01 412
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 412
Number of participants with account balances 2012-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 464
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 265
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 36
Total of all active and inactive participants 2011-01-01 301
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 301
Number of participants with account balances 2011-01-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2010: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 434
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 338
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 39
Total of all active and inactive participants 2010-01-01 377
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 377
Number of participants with account balances 2010-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 534
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 339
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 38
Total of all active and inactive participants 2009-01-01 377
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 377
Number of participants with account balances 2009-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	99
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	66
Total of all active and inactive participants	2015-01-01	165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	165
Number of participants with account balances	2015-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	165
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	0
Total of all active and inactive participants	2014-01-01	165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	165
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	512
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	88
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	52
Total of all active and inactive participants	2013-01-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	140
Number of participants with account balances	2013-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	309
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	370
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	42
Total of all active and inactive participants	2012-01-01	412
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	412
Number of participants with account balances	2012-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	464
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	265
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	36
Total of all active and inactive participants	2011-01-01	301
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	301
Number of participants with account balances	2011-01-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2010: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	434
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	338
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	39
Total of all active and inactive participants	2010-01-01	377
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	377
Number of participants with account balances	2010-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	534
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	339
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	38
Total of all active and inactive participants	2009-01-01	377
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	377
Number of participants with account balances	2009-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2015 : OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 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	$879,195
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$162,713
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$154,549
Expenses. Certain deemed distributions of participant loans	2015-12-31	$977
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$131,689
Value of total assets at end of year	2015-12-31	$716,482
Value of total assets at beginning of year	2015-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$7,187
Total interest from all sources	2015-12-31	$395
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$26,321
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$26,321
Assets. Real estate other than employer real property at beginning of year	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	No
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$81,695
Participant contributions at end of year	2015-12-31	$6,610
Participant contributions at beginning of year	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$7,187
Liabilities. Value of operating payables at beginning of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$716,482
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$716,482
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$0
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
Assets. partnership/joint venture interests at beginning of year	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$707,900
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$0
Interest on participant loans	2015-12-31	$393
Value of interest in master investment trust accounts at end of year	2015-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2015-12-31	$0
Value of interest in common/collective trusts at end of year	2015-12-31	$0
Value of interest in common/collective trusts at beginning of year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$1,972
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$2
Assets. Value of investments in 103.12 investment entities at end of year	2015-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2015-12-31	$0
Asset value of US Government securities at beginning of year	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$720,790
Net investment gain/loss from pooled separate accounts	2015-12-31	$0
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Net gain/loss from 103.12 investment entities	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Assets. Value of employer real property at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$49,994
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$154,549
Asset. Corporate debt instrument preferred debt at beginning of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2015-12-31	$0
Contract administrator fees	2015-12-31	$0
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	2015-12-31	No
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2015-12-31	$0
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
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
2014 : OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$0
Expenses. Total of all expenses incurred	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$0
Total plan assets at beginning of year	2014-12-31	$0
Value of fidelity bond covering the plan	2014-12-31	$0
Total contributions received or receivable from participants	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$0
2013 : OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$225,879
Total of all expenses incurred	2013-12-31	$51,623
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$46,816
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$64,339
Value of total assets at end of year	2013-12-31	$913,363
Value of total assets at beginning of year	2013-12-31	$739,107
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$4,807
Total interest from all sources	2013-12-31	$1,093
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$700,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$37,211
Participant contributions at end of year	2013-12-31	$25,613
Participant contributions at beginning of year	2013-12-31	$32,720
Participant contributions at beginning of year	2013-12-31	$4,225
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$90
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	$174,256
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$913,363
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$739,107
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	$869,601
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$681,620
Interest on participant loans	2013-12-31	$1,093
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$18,149
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$17,900
Net investment gain/loss from pooled separate accounts	2013-12-31	$160,357
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
Contributions received in cash from employer	2013-12-31	$27,128
Employer contributions (assets) at beginning of year	2013-12-31	$2,642
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$46,816
Contract administrator fees	2013-12-31	$4,807
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	EIDE BAILLY LLP
Accountancy firm EIN	2013-12-31	450250958
2012 : OCURRANCE INC 401(K) PROFIT SHARING PLAN & 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	$172,907
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$130,895
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$125,931
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$86,580
Value of total assets at end of year	2012-12-31	$739,107
Value of total assets at beginning of year	2012-12-31	$697,095
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$4,964
Total interest from all sources	2012-12-31	$331
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$70,000
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	$50,734
Participant contributions at end of year	2012-12-31	$32,720
Participant contributions at beginning of year	2012-12-31	$35,305
Participant contributions at end of year	2012-12-31	$4,225
Participant contributions at beginning of year	2012-12-31	$2,009
Other income not declared elsewhere	2012-12-31	$126
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$42,012
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$739,107
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$697,095
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	$681,620
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$630,497
Interest on participant loans	2012-12-31	$331
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$17,900
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$27,696
Net investment gain/loss from pooled separate accounts	2012-12-31	$85,870
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
Contributions received in cash from employer	2012-12-31	$35,846
Employer contributions (assets) at end of year	2012-12-31	$2,642
Employer contributions (assets) at beginning of year	2012-12-31	$1,588
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$125,931
Contract administrator fees	2012-12-31	$4,964
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	2012-12-31	No
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	EIDE BAILLY LLP
Accountancy firm EIN	2012-12-31	450250958
2011 : OCURRANCE INC 401(K) PROFIT SHARING PLAN & 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	$102,938
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$172,551
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$162,721
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$94,430
Value of total assets at end of year	2011-12-31	$697,095
Value of total assets at beginning of year	2011-12-31	$766,708
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$9,830
Total interest from all sources	2011-12-31	$1,454
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$70,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$54,420
Participant contributions at end of year	2011-12-31	$35,305
Participant contributions at beginning of year	2011-12-31	$63,785
Participant contributions at end of year	2011-12-31	$2,009
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$16
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$150
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$163
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	$-69,613
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$697,095
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$766,708
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	$702,744
Value of interest in pooled separate accounts at end of year	2011-12-31	$630,497
Interest on participant loans	2011-12-31	$1,454
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$27,696
Net investment gain/loss from pooled separate accounts	2011-12-31	$7,054
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	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$39,860
Employer contributions (assets) at end of year	2011-12-31	$1,588
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$162,721
Contract administrator fees	2011-12-31	$9,830
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	2011-12-31	No
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	LAKE, HILL AND MYERS
Accountancy firm EIN	2011-12-31	870491579
2010 : OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	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
Expenses. Interest paid	2010-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$209,504
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$104,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$91,001
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$115,036
Value of total assets at end of year	2010-12-31	$766,708
Value of total assets at beginning of year	2010-12-31	$661,753
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$13,548
Total income from rents	2010-12-31	$0
Total interest from all sources	2010-12-31	$2,660
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$0
Assets. Real estate other than employer real property at end of year	2010-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2010-12-31	$0
Administrative expenses professional fees incurred	2010-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$70,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$65,421
Participant contributions at end of year	2010-12-31	$63,785
Participant contributions at beginning of year	2010-12-31	$53,613
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$2,761
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$16
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$163
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$150
Assets. Loans (other than to participants) at end of year	2010-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$0
Liabilities. Value of operating payables at end of year	2010-12-31	$0
Liabilities. Value of operating payables at beginning of year	2010-12-31	$0
Total non interest bearing cash at end of year	2010-12-31	$0
Total non interest bearing cash at beginning of year	2010-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Income. Non cash contributions	2010-12-31	$0
Value of net income/loss	2010-12-31	$104,955
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$766,708
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$661,753
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
Assets. partnership/joint venture interests at end of year	2010-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2010-12-31	$0
Investment advisory and management fees	2010-12-31	$11,943
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$702,744
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$603,204
Value of interest in pooled separate accounts at end of year	2010-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$0
Interest on participant loans	2010-12-31	$2,660
Income. Interest from loans (other than to participants)	2010-12-31	$0
Interest earned on other investments	2010-12-31	$0
Income. Interest from US Government securities	2010-12-31	$0
Income. Interest from corporate debt instruments	2010-12-31	$0
Value of interest in master investment trust accounts at end of year	2010-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2010-12-31	$0
Value of interest in common/collective trusts at end of year	2010-12-31	$0
Value of interest in common/collective trusts at beginning of year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2010-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2010-12-31	$0
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
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Asset value of US Government securities at end of year	2010-12-31	$0
Asset value of US Government securities at beginning of year	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$91,808
Net investment gain/loss from pooled separate accounts	2010-12-31	$0
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Net gain/loss from 103.12 investment entities	2010-12-31	$0
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
Assets. Invements in employer securities at end of year	2010-12-31	$0
Assets. Invements in employer securities at beginning of year	2010-12-31	$0
Assets. Value of employer real property at end of year	2010-12-31	$0
Assets. Value of employer real property at beginning of year	2010-12-31	$0
Contributions received in cash from employer	2010-12-31	$49,615
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$2,025
Income. Dividends from preferred stock	2010-12-31	$0
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$91,001
Asset. Corporate debt instrument preferred debt at end of year	2010-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2010-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2010-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2010-12-31	$0
Contract administrator fees	2010-12-31	$1,605
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2010-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2010-12-31	$0
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-12-31	$0
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	LAKE HILL & MYERS
Accountancy firm EIN	2010-12-31	870491579

Form 5500 Responses for OCURRANCE INC 401(K) PROFIT SHARING PLAN & TRUST

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

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

802511

Policy instance

Insurance contract or identification number	802511
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

802511

Policy instance

Insurance contract or identification number	802511
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $235
Total amount of fees paid to insurance company	USD $0
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
Insurance broker organization code?	3
Insurance broker name	SOUTH COAST ASSURANCE

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

802511

Policy instance

Insurance contract or identification number	802511
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,199
Total amount of fees paid to insurance company	USD $0
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

26243

Policy instance

Insurance contract or identification number	26243
Number of Individuals Covered	89
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,172
Total amount of fees paid to insurance company	USD $1,605

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Company Name:	OCURRANCE INC
Employer identification number (EIN):	870524420
NAIC Classification:	561420