Schedule A
- Row 1
- Filing Id
- 84037252615055
- Form Id
- 61451205
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 4010375252615050002
- Ins Broker 01 Name
- VSR FINANCIAL SERVICES
- Ins Broker 01 State
- MI
- Ins Broker 01 ZIP Code
- 486086517
- Ins Broker Comm Pd 01 Amount
- $1,086
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 2
- Filing Id
- 84037252615055
- Form Id
- 61451205
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 4010375252615050002
- Ins Broker 01 Name
- DAVID ZORN
- Ins Broker Comm Pd 01 Amount
- $396
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 3
- Filing Id
- 84037252615055
- Form Id
- 61451205
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 2
- Image Form Id
- 4010375252615050002
- Ins Broker 01 Name
- KDP RETIREMENT PLAN SERVICES INC
- Ins Broker 01 Street Addr
- 1550 LEONARD NE
- Ins Broker 01 City
- GRAND RAPIDS
- Ins Broker 01 State
- MI
- Ins Broker 01 ZIP Code
- 495050000
- Ins Broker Comm Pd 01 Amount
- $155
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Text
- TPA FORUM COMPENSATION
- Ins Broker 01 Code
- 5
- Row 4
- Ins Carrier Name: MANULIFE FINANCIAL (USA)
- Filing Id
- 84037252615055
- Form Id
- 61451205
- Schedule A EIN
- 38-3256728
- Schedule A Plan Num
- 001
- Schedule A Plan Year Begin Date
- 2004-01-01
- Schedule A Tax Period
- 20041231
- Ins Carrier Name
- MANULIFE FINANCIAL (USA)
- Ins Carrier EIN
- 01-0233346
- Ins Carrier Naic Code
- 65838
- Ins Contract Num
- 15355
- Ins Prsn Covered End of year Count
- 16
- Ins Policy From Date
- 2004-01-01
- Ins Policy To Date
- 2004-12-31
- Ins Broker Comm Total Amount
- $1,637
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pnsn Type Unalloc Cntrct I
- 1
- 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
Schedule D
- Row 1
- Filing Id
- 84037252615055
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 4010375252615050003
- Row 2
- Filing Id
- 84037252615055
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MANULIFE LIFESTYLE BALANCED
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $45,805
- Row 3
- Filing Id
- 84037252615055
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MANULIFE LIFESTYLE GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $98,682
- Row 4
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 1
- Row Num
- 10
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC MORGAN STANLEY EQUITY GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $206
- Row 5
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 2
- Row Num
- 11
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC JANUS ADVISER WORLDWIDE
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 6
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 3
- Row Num
- 12
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC TEMPLETON FOREIGN
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $5,981
- Row 7
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 4
- Row Num
- 13
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC SCUDDER INTL SELECT EQUITY
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $466
- Row 8
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 5
- Row Num
- 14
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC JANUS TWENTY
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 9
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 6
- Row Num
- 15
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC AIM AGRESSIVE GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $435
- Row 10
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 1
- Row Num
- 16
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC T ROWE PRICE SCI & TECH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $434
- Row 11
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 2
- Row Num
- 17
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- 500 INDEX FUND
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 12
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 3
- Row Num
- 18
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC AMERICAN FUNDS AM BALANCED
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $22,224
- Row 13
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 4
- Row Num
- 19
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC DAVIS NEW YORK VENTURE
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $1,737
- Row 14
- Filing Id
- 84037252615055
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 2
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MANULIFE LIFESTYLE AGGRESSIVE
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $24,187
- Row 15
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 5
- Row Num
- 20
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC WEITZ PARTNERS VALUE
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,287
- Row 16
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 6
- Row Num
- 21
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC MFS UTILITIES
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $3,112
- Row 17
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 1
- Row Num
- 22
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC AMERICAN FUNDS GROWTH FUND
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $6,282
- Row 18
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 2
- Row Num
- 23
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC OPPENHEIMER GLOBAL
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $447
- Row 19
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 3
- Row Num
- 24
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC ENERGY
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $12,225
- Row 20
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 4
- Row Num
- 25
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC SMITH BARNEY AFF GROWTH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,084
- Row 21
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 5
- Row Num
- 26
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC OPPENHEIMER DEVELOPING MKT
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $16,165
- Row 22
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 3
- Page Row Num
- 6
- Row Num
- 27
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC PIMCO RCM GLOBAL TECH
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $15,575
- Row 23
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 4
- Page Row Num
- 1
- Row Num
- 28
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- QUANTITATIVE MID CAP FUND (VS)
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $15,870
- Row 24
- Filing Id
- 84037252615055
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 4
- Row Num
- 3
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MANULIFE MONEY MARKET
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,116
- Row 25
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 4
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC SHORT-TERM FEDERAL
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 26
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 5
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC PIMCO TOTAL RETURN
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $33,130
- Row 27
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 6
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC MUTUAL BEACON
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $7,661
- Row 28
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 4
- Row Num
- 7
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC FRANKLIN BALANCE SHEET
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $15,812
- Row 29
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 5
- Row Num
- 8
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC MUTUAL DISCOVERY
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $4,003
- Row 30
- Filing Id
- 84037252615055
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 6
- Row Num
- 9
- Image Form Id
- 4010375252615050003
- DFE P1 Entity 01 Name
- MFC T ROWE PRICE BLUE CHIP
- DFE P1 Spons 01 Name
- MANUFACTURERS LIFE INS CO (USA)
- DFE P1 Plan 01 EIN Plan number
- 010233346000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $157