401k Plan data: DAVE'S KILLER BREAD 401(K) PLAN plan

DAVE'S KILLER BREAD 401(K) PLAN 401k Plan overview

Plan Name	DAVE'S KILLER BREAD 401(K) PLAN
Plan identification number	001

DAVE'S KILLER BREAD 401(K) 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.

401k Sponsoring company profile

AVB INC. DBA DAVES KILLER BREAD has sponsored the creation of one or more 401k plans.

Company Name: AVB INC. DBA DAVES KILLER BREAD

Employer identification number (EIN): 930948847

NAIC Classification: 445291
NAIC Description: Baked Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVE'S KILLER BREAD 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 KAREN HICKEY
001 2015-01-01 KAREN HICKEY
001 2014-01-01 GINA DELAHUNT
001 2013-01-01 GINA DELAHUNT
001 2012-01-01 SARA WREDE
001 2011-01-01 SARA WREDE
001 2010-01-01 GLENN DAHL 2011-10-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	KAREN HICKEY
001	2015-01-01	KAREN HICKEY
001	2014-01-01	GINA DELAHUNT
001	2013-01-01	GINA DELAHUNT
001	2012-01-01	SARA WREDE
001	2011-01-01	SARA WREDE
001	2010-01-01	GLENN DAHL	2011-10-12

Plan Statistics for DAVE'S KILLER BREAD 401(K) PLAN

401k plan membership statisitcs for DAVE'S KILLER BREAD 401(K) PLAN

Measure Date Value
2016: DAVE'S KILLER BREAD 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: DAVE'S KILLER BREAD 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 254
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 265
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 11
Total of all active and inactive participants 2015-01-01 276
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 276
Number of participants with account balances 2015-01-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: DAVE'S KILLER BREAD 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 241
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 242
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 12
Total of all active and inactive participants 2014-01-01 254
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 254
Number of participants with account balances 2014-01-01 125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: DAVE'S KILLER BREAD 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 234
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 7
Total of all active and inactive participants 2013-01-01 241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 241
Number of participants with account balances 2013-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: DAVE'S KILLER BREAD 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 218
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 7
Total of all active and inactive participants 2012-01-01 225
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 225
Number of participants with account balances 2012-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: DAVE'S KILLER BREAD 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 164
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 1
Total of all active and inactive participants 2011-01-01 165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 165
Number of participants with account balances 2011-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2016: DAVE'S KILLER BREAD 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: DAVE'S KILLER BREAD 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	254
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	265
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	11
Total of all active and inactive participants	2015-01-01	276
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	276
Number of participants with account balances	2015-01-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: DAVE'S KILLER BREAD 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	241
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	242
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	12
Total of all active and inactive participants	2014-01-01	254
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	254
Number of participants with account balances	2014-01-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: DAVE'S KILLER BREAD 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	234
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	7
Total of all active and inactive participants	2013-01-01	241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	241
Number of participants with account balances	2013-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: DAVE'S KILLER BREAD 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	218
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	7
Total of all active and inactive participants	2012-01-01	225
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	225
Number of participants with account balances	2012-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: DAVE'S KILLER BREAD 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	164
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	1
Total of all active and inactive participants	2011-01-01	165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	165
Number of participants with account balances	2011-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on DAVE'S KILLER BREAD 401(K) PLAN

Measure	Date	Value
2016 : DAVE'S KILLER BREAD 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-04-01	$0
Total transfer of assets from this plan	2016-04-01	$3,248,285
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-04-01	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-04-01	$0
Total income from all sources (including contributions)	2016-04-01	$-66,028
Total loss/gain on sale of assets	2016-04-01	$0
Total of all expenses incurred	2016-04-01	$632,891
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-04-01	$629,482
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-04-01	$0
Value of total assets at end of year	2016-04-01	$0
Value of total assets at beginning of year	2016-04-01	$3,947,204
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-04-01	$3,409
Total interest from all sources	2016-04-01	$3
Total dividends received (eg from common stock, registered investment company shares)	2016-04-01	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-04-01	No
Was this plan covered by a fidelity bond	2016-04-01	Yes
Value of fidelity bond cover	2016-04-01	$394,721
If this is an individual account plan, was there a blackout period	2016-04-01	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-04-01	$0
Were there any nonexempt tranactions with any party-in-interest	2016-04-01	No
Participant contributions at end of year	2016-04-01	$0
Participant contributions at beginning of year	2016-04-01	$7,363
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-04-01	No
Value of net income/loss	2016-04-01	$-698,919
Value of net assets at end of year (total assets less liabilities)	2016-04-01	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-04-01	$3,947,204
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-04-01	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-04-01	No
Were any leases to which the plan was party in default or uncollectible	2016-04-01	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-04-01	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-04-01	$3,906,877
Interest earned on other investments	2016-04-01	$3
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-04-01	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-04-01	$813
Net investment gain/loss from pooled separate accounts	2016-04-01	$-66,031
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-04-01	Yes
Was there a failure to transmit to the plan any participant contributions	2016-04-01	No
Has the plan failed to provide any benefit when due under the plan	2016-04-01	No
Employer contributions (assets) at end of year	2016-04-01	$0
Employer contributions (assets) at beginning of year	2016-04-01	$32,151
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-04-01	$629,482
Contract administrator fees	2016-04-01	$3,409
Did the plan have assets held for investment	2016-04-01	No
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	2016-04-01	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-04-01	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-04-01	Yes
Opinion of an independent qualified public accountant for this plan	2016-04-01	Disclaimer
Accountancy firm name	2016-04-01	CARR, RIGGS AND INGRAM, LLC
Accountancy firm EIN	2016-04-01	721396621
2015 : DAVE'S KILLER BREAD 401(K) 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	$334
Total income from all sources (including contributions)	2015-12-31	$1,229,479
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$147,356
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$133,378
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,233,367
Value of total assets at end of year	2015-12-31	$3,947,204
Value of total assets at beginning of year	2015-12-31	$2,865,415
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$13,978
Total interest from all sources	2015-12-31	$6
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	$286,541
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	$733,618
Participant contributions at end of year	2015-12-31	$7,363
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	$13,689
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$334
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	$1,082,123
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,947,204
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,865,081
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 registered invesment companies (eg mutual funds) at end of year	2015-12-31	$3,906,877
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,833,010
Interest earned on other investments	2015-12-31	$6
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$813
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$10,746
Net investment gain/loss from pooled separate accounts	2015-12-31	$-3,894
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
Contributions received in cash from employer	2015-12-31	$486,060
Employer contributions (assets) at end of year	2015-12-31	$32,151
Employer contributions (assets) at beginning of year	2015-12-31	$21,659
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$133,378
Contract administrator fees	2015-12-31	$13,978
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	ERICKSON & CARNEGIE, LLP
Accountancy firm EIN	2015-12-31	465607846
2014 : DAVE'S KILLER BREAD 401(K) 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	$334
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	$767,595
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$588,170
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$576,764
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$621,171
Value of total assets at end of year	2014-12-31	$2,865,415
Value of total assets at beginning of year	2014-12-31	$2,685,656
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$11,406
Total interest from all sources	2014-12-31	$77
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$268,566
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	$339,810
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$276,821
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$42,938
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$334
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$3,455
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	$179,425
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,865,081
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,685,656
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 registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,833,010
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,389,062
Interest earned on other investments	2014-12-31	$77
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$10,746
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$10,383
Net investment gain/loss from pooled separate accounts	2014-12-31	$142,892
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	Yes
Contributions received in cash from employer	2014-12-31	$238,423
Employer contributions (assets) at end of year	2014-12-31	$21,659
Employer contributions (assets) at beginning of year	2014-12-31	$9,390
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$576,764
Contract administrator fees	2014-12-31	$11,406
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	ERICKSON & CARNEGIE, LLP
Accountancy firm EIN	2014-12-31	465607846
2013 : DAVE'S KILLER BREAD 401(K) 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	$1,300,863
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$146,484
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$136,262
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$944,535
Value of total assets at end of year	2013-12-31	$2,685,656
Value of total assets at beginning of year	2013-12-31	$1,531,277
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$10,222
Total interest from all sources	2013-12-31	$75
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$153,128
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	$291,793
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$1,306
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$276,821
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$256,904
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$462,142
Other income not declared elsewhere	2013-12-31	$23,879
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	$1,154,379
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,685,656
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,531,277
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 registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,389,062
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,253,916
Interest earned on other investments	2013-12-31	$75
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$10,383
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$9,427
Net investment gain/loss from pooled separate accounts	2013-12-31	$332,374
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	Yes
Contributions received in cash from employer	2013-12-31	$190,600
Employer contributions (assets) at end of year	2013-12-31	$9,390
Employer contributions (assets) at beginning of year	2013-12-31	$9,724
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$136,262
Contract administrator fees	2013-12-31	$10,222
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	FREDERICK K ERICKSON CPA
Accountancy firm EIN	2013-12-31	911802884
2012 : DAVE'S KILLER BREAD 401(K) 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	$600,381
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$26,424
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$14,859
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$450,955
Value of total assets at end of year	2012-12-31	$1,531,277
Value of total assets at beginning of year	2012-12-31	$957,320
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$11,565
Total interest from all sources	2012-12-31	$71
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	$153,128
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	$206,111
Participant contributions at end of year	2012-12-31	$1,306
Participant contributions at beginning of year	2012-12-31	$2,819
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$256,904
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$216,435
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$84,268
Other income not declared elsewhere	2012-12-31	$21,649
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	$573,957
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,531,277
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$957,320
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 registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,253,916
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$726,736
Interest earned on other investments	2012-12-31	$71
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$9,427
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$127
Net investment gain/loss from pooled separate accounts	2012-12-31	$127,706
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	$160,576
Employer contributions (assets) at end of year	2012-12-31	$9,724
Employer contributions (assets) at beginning of year	2012-12-31	$11,203
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$14,859
Contract administrator fees	2012-12-31	$11,565
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	FREDERICK K ERICKSON CPA
Accountancy firm EIN	2012-12-31	911802884
2011 : DAVE'S KILLER BREAD 401(K) 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	$0
Total income from all sources (including contributions)	2011-12-31	$224,588
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$85,603
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$74,950
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$253,493
Value of total assets at end of year	2011-12-31	$957,320
Value of total assets at beginning of year	2011-12-31	$818,335
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$10,653
Total interest from all sources	2011-12-31	$0
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	$150,000
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	$135,059
Participant contributions at end of year	2011-12-31	$2,819
Participant contributions at beginning of year	2011-12-31	$1,786
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$216,435
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$147,293
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$10,229
Other income not declared elsewhere	2011-12-31	$-7,934
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	$138,985
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$957,320
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$818,335
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 end of year	2011-12-31	$726,736
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$663,570
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$127
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-20,971
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
Contributions received in cash from employer	2011-12-31	$108,205
Employer contributions (assets) at end of year	2011-12-31	$11,203
Employer contributions (assets) at beginning of year	2011-12-31	$5,686
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$74,950
Contract administrator fees	2011-12-31	$10,653
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	FREDERICK K ERICKSON CPA
Accountancy firm EIN	2011-12-31	911802884

Form 5500 Responses for DAVE'S KILLER BREAD 401(K) PLAN

2016: DAVE'S KILLER BREAD 401(K) 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: DAVE'S KILLER BREAD 401(K) 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: DAVE'S KILLER BREAD 401(K) 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: DAVE'S KILLER BREAD 401(K) 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: DAVE'S KILLER BREAD 401(K) 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: DAVE'S KILLER BREAD 401(K) 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

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

21593

Policy instance

Insurance contract or identification number	21593
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2016-04-01
Total amount of commissions paid to insurance broker	USD $2,939
Total amount of fees paid to insurance company	USD $592
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 $2,939
Insurance broker organization code?	3
Amount paid for insurance broker fees	592
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker name	PENSION PLAN SPECIALISTS, PC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

PFT5071

Policy instance

Insurance contract or identification number	PFT5071
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $221
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $221
Insurance broker organization code?	3
Insurance broker name	RICH KELLY FINANCIAL SERVICES

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

Policy contract number

21593

Policy instance

Insurance contract or identification number	21593
Number of Individuals Covered	148
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,116
Total amount of fees paid to insurance company	USD $1,629
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 $8,116
Insurance broker organization code?	3
Amount paid for insurance broker fees	1629
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES & OTHER ALLOWANCES
Insurance broker name	PENSION PLAN SPECIALISTS, PC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

PFT5071

Policy instance

Insurance contract or identification number	PFT5071
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $824
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $824
Insurance broker organization code?	3
Insurance broker name	RICH KELLY FINANCIAL SERVICES

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VR08047668

Policy instance

Insurance contract or identification number	VR08047668
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $473
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $473
Insurance broker organization code?	3
Insurance broker name	EQUITY SERVICES INC

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

Policy contract number

21593

Policy instance

Insurance contract or identification number	21593
Number of Individuals Covered	131
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,459
Total amount of fees paid to insurance company	USD $1,342
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 $8,459
Insurance broker organization code?	3
Amount paid for insurance broker fees	1342
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	PENSION PLAN SPECIALISTS, PC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

PFT5071

Policy instance

Insurance contract or identification number	PFT5071
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $747
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $747
Insurance broker organization code?	3
Insurance broker name	RICH KELLY FINANCIAL SERVICES

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VR08047668

Policy instance

Insurance contract or identification number	VR08047668
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,856
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $1,856
Insurance broker organization code?	3
Insurance broker name	EQUITY SERVICES INC

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

Policy contract number

21593

Policy instance

Insurance contract or identification number	21593
Number of Individuals Covered	109
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,519
Total amount of fees paid to insurance company	USD $962
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 $7,519
Insurance broker organization code?	3
Amount paid for insurance broker fees	962
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	PENSION PLAN SPECIALISTS, PC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

PFT5071

Policy instance

Insurance contract or identification number	PFT5071
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,552
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $1,552
Insurance broker organization code?	3
Insurance broker name	RICH KELLY FINANCIAL SERVICES

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VR08047668

Policy instance

Insurance contract or identification number	VR08047668
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,433
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $2,433
Insurance broker organization code?	3
Insurance broker name	EQUITY SERVICES INC

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

Policy contract number

21593

Policy instance

Insurance contract or identification number	21593
Number of Individuals Covered	103
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,225
Total amount of fees paid to insurance company	USD $495
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
Amount paid for insurance broker fees	495
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $4,225
Insurance broker name	EQUITY SERVICES INC-NATL LIFE OF VT

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

Policy contract number

21593

Policy instance

Insurance contract or identification number	21593
Number of Individuals Covered	58
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,527
Total amount of fees paid to insurance company	USD $370
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

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VR08047668

Policy instance

Insurance contract or identification number	VR08047668
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,488
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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

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Company Name:	AVB INC. DBA DAVES KILLER BREAD
Employer identification number (EIN):	930948847
NAIC Classification:	445291
NAIC Description:	Baked Goods Stores