Schedule A
- Row 1
- Filing Id
- 91037156136442
- Form Id
- 16354429
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 40372037113020002
- Ins Broker 01 Name
- THOMAS OLEXA
- Ins Broker 01 Street Addr
- 53 WEST WACKER DRIVE #410
- Ins Broker 01 City
- CHICAGO
- Ins Broker 01 State
- IL
- Ins Broker 01 ZIP Code
- 60601
- Ins Broker Comm Pd 01 Amount
- $2,908
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 2
- Filing Id
- 91037156136442
- Form Id
- 16354430
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 40372037113020003
- Ins Broker 01 Name
- THOMAS OLEXZ
- Ins Broker 01 Street Addr
- 53 WEST WACKER DRIVE #410
- Ins Broker 01 City
- CHICAGO
- Ins Broker 01 State
- IL
- Ins Broker 01 ZIP Code
- 60601
- Ins Broker Comm Pd 01 Amount
- $51
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 3
- Ins Carrier Name: MANULIFE FINANCIAL (USA)
- Filing Id
- 91037156136442
- Form Id
- 16354430
- Schedule A EIN
- 36-3090607
- Schedule A Plan Num
- 002
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- MANULIFE FINANCIAL (USA)
- Ins Carrier EIN
- 01-0233346
- Ins Carrier Naic Code
- 65838
- Ins Contract Num
- 74484
- Ins Prsn Covered End of year Count
- 19
- Ins Policy From Date
- 2000-10-11
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $51
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $877,908
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension Type Alloc Cntrct Indicator
- No
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 4
- Ins Carrier Name: NATIONWIDE LIFE INSURANCE CO.
- Filing Id
- 91037156136442
- Form Id
- 16354429
- Schedule A EIN
- 36-3090607
- Schedule A Plan Num
- 002
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- NATIONWIDE LIFE INSURANCE CO.
- Ins Carrier EIN
- 31-4156830
- Ins Carrier Naic Code
- 66869
- Ins Contract Num
- ASBE00IL00K1
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-10-11
- Ins Broker Comm Total Amount
- $2,908
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Basis Rates Text
- NOT PROVIDED
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pnsn Type Unalloc Cntrct I
- 3
- Pension End Prev Bal Amount
- $112,393
- Pension Contribution Dep Amount
- $1,953
- Pension Divnd Cr Dep Amount
- $3,093
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $25,000
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $30,046
- Pension Total Bal Addn Amount
- $142,439
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $6
- Pension Transfer To Amount
- $42,147
- Pension Oth Ded Amount
- $100,286
- Pension Oth Ded Text
- TRUST ASSET TRANSFER
- Pension Total Ded Amount
- $142,439
- Pension End of year Bal Amount
- $0
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
Schedule D
- Row 1
- Filing Id
- 91037156136442
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 40372037113020004
- Row 2
- Filing Id
- 91037156136442
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- LIFE STYLE BALANCED
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $69,055
- Row 3
- Filing Id
- 91037156136442
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- LIFE STYLE GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $14,139
- Row 4
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 1
- Row Num
- 10
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- EQUITY INCOME
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $4,189
- Row 5
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 2
- Row Num
- 11
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- USLCV
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $927
- Row 6
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 3
- Row Num
- 12
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- GROWTH & INCOME
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $160
- Row 7
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 4
- Row Num
- 13
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- BLUE CHIP
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $71,884
- Row 8
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 5
- Row Num
- 14
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- QUANTITATIVE MID CAP
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $19,130
- Row 9
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 6
- Row Num
- 15
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- TOTAL STOCK MARKET INDEX
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $1,278
- Row 10
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 1
- Row Num
- 16
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- LARGE CAP GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $4,133
- Row 11
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 2
- Row Num
- 17
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $1,584
- Row 12
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 3
- Row Num
- 18
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- SMALL CAP
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $341
- Row 13
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 4
- Row Num
- 19
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- MID CAP INDEX
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $332
- Row 14
- Filing Id
- 91037156136442
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 2
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- LIFE STYLE AGGRESSIVE
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $38,978
- Row 15
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 5
- Row Num
- 20
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- MIDBL
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $1,822
- Row 16
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 6
- Row Num
- 21
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- IT VL
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $28,090
- Row 17
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 1
- Row Num
- 22
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- OVERSEAS FUND
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $928
- Row 18
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 2
- Row Num
- 23
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- ALL CAP GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSUARNCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $112,399
- Row 19
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 3
- Row Num
- 24
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- MID CAP GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $1,504
- Row 20
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 4
- Row Num
- 25
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- SMALL CAP INDEX
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $246
- Row 21
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 5
- Row Num
- 26
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- EMGR
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $35,697
- Row 22
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 6
- Row Num
- 27
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- AGGRESSIVE GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $975
- Row 23
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 4
- Page Row Num
- 1
- Row Num
- 28
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- SCIENCE & TECHNOLOGY
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $37,543
- Row 24
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 4
- Page Row Num
- 2
- Row Num
- 29
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- INTERNET TECHNOLOGY
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,625
- Row 25
- Filing Id
- 91037156136442
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 4
- Row Num
- 3
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- MONEY MARKET FUND
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $282,536
- Row 26
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 4
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- U.S. GOVERNMENT
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $124,168
- Row 27
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 5
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- TOTAL RETURN
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,013
- Row 28
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 6
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- BOND FUND
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,008
- Row 29
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 4
- Row Num
- 7
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- HIGH YIELD
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $16,546
- Row 30
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 5
- Row Num
- 8
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- BALANCED
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $639
- Row 31
- Filing Id
- 91037156136442
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 6
- Row Num
- 9
- Image Form Id
- 40372037113020004
- DFE P1 Entity 01 Name
- INCOME & VALUE
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INSURANCE CO.
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,039