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CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameCENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN
Plan identification number 002

CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

CENTRAL MAINE ORTHOPAEDICS, P.A. has sponsored the creation of one or more 401k plans.

Company Name:CENTRAL MAINE ORTHOPAEDICS, P.A.
Employer identification number (EIN):010416156
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022016-01-01
0022015-01-01
0022014-01-01JANICE FOURNIER2015-07-14
0022013-01-01JANICE FOURNIER2014-06-03
0022012-01-01JANICE FOURNIER
0022011-01-01JANICE FOURNIER
0022010-01-01JANICE FOURNIER
0022009-01-01CAROL LIPMAN

Plan Statistics for CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2012: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01102
Total number of active participants reported on line 7a of the Form 55002012-01-0167
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0130
Total of all active and inactive participants2012-01-0197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0197
Number of participants with account balances2012-01-0189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0110
2011: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01117
Total number of active participants reported on line 7a of the Form 55002011-01-0178
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0123
Total of all active and inactive participants2011-01-01101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01101
Number of participants with account balances2011-01-0191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-016
2010: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01139
Total number of active participants reported on line 7a of the Form 55002010-01-0174
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0142
Total of all active and inactive participants2010-01-01116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01116
Number of participants with account balances2010-01-01112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-014
2009: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01132
Total number of active participants reported on line 7a of the Form 55002009-01-0169
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0170
Total of all active and inactive participants2009-01-01139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01139
Number of participants with account balances2009-01-01132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-019

Financial Data on CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2012 : CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$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$1,447,267
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$152,661
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$148,203
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$641,108
Value of total assets at end of year2012-12-31$6,867,361
Value of total assets at beginning of year2012-12-31$5,572,755
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$4,458
Total interest from all sources2012-12-31$1,889
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$10,209
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$9,088
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$700,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$271,065
Participant contributions at end of year2012-12-31$67,563
Participant contributions at beginning of year2012-12-31$42,281
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$8,659
Administrative expenses (other) incurred2012-12-31$4,458
Total non interest bearing cash at end of year2012-12-31$13,814
Total non interest bearing cash at beginning of year2012-12-31$12,052
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$1,294,606
Value of net assets at end of year (total assets less liabilities)2012-12-31$6,867,361
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$5,572,755
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$922,920
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$823,768
Value of interest in pooled separate accounts at end of year2012-12-31$5,540,115
Value of interest in pooled separate accounts at beginning of year2012-12-31$4,337,581
Interest on participant loans2012-12-31$1,886
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$8,359
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$7,898
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$7,898
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$3
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$99,132
Net investment gain/loss from pooled separate accounts2012-12-31$694,929
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$361,384
Employer contributions (assets) at end of year2012-12-31$247,319
Employer contributions (assets) at beginning of year2012-12-31$289,505
Income. Dividends from common stock2012-12-31$1,121
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$148,203
Assets. Corporate common stocks other than exployer securities at end of year2012-12-31$67,271
Assets. Corporate common stocks other than exployer securities at beginning of year2012-12-31$59,670
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31BAKER NEWMAN NOYES
Accountancy firm EIN2012-12-31010494526
2011 : CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$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$429,989
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$805,290
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$801,597
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$663,373
Value of total assets at end of year2011-12-31$5,572,755
Value of total assets at beginning of year2011-12-31$5,948,056
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$3,693
Total interest from all sources2011-12-31$5,971
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$13,135
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$12,110
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$700,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$275,738
Participant contributions at end of year2011-12-31$42,281
Participant contributions at beginning of year2011-12-31$41,925
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$6,880
Administrative expenses (other) incurred2011-12-31$3,693
Total non interest bearing cash at end of year2011-12-31$12,052
Total non interest bearing cash at beginning of year2011-12-31$31,356
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-375,301
Value of net assets at end of year (total assets less liabilities)2011-12-31$5,572,755
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$5,948,056
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$823,768
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$870,641
Value of interest in pooled separate accounts at end of year2011-12-31$4,337,581
Value of interest in pooled separate accounts at beginning of year2011-12-31$4,662,044
Interest on participant loans2011-12-31$1,376
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$7,898
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$27,227
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$27,227
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$4,595
Net investment gain/loss from pooled separate accounts2011-12-31$-252,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$380,755
Employer contributions (assets) at end of year2011-12-31$289,505
Employer contributions (assets) at beginning of year2011-12-31$264,234
Income. Dividends from common stock2011-12-31$1,025
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$801,597
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$59,670
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$50,629
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31BAKER NEWMAN NOYES
Accountancy firm EIN2011-12-31010494526
2010 : CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$1,336,710
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$1,032,166
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,028,138
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$708,150
Value of total assets at end of year2010-12-31$5,948,056
Value of total assets at beginning of year2010-12-31$5,643,512
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$4,028
Total interest from all sources2010-12-31$1,849
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$11,325
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$10,781
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$262,997
Participant contributions at end of year2010-12-31$41,925
Participant contributions at beginning of year2010-12-31$49,812
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$42,587
Administrative expenses (other) incurred2010-12-31$4,028
Total non interest bearing cash at end of year2010-12-31$31,356
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$304,544
Value of net assets at end of year (total assets less liabilities)2010-12-31$5,948,056
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$5,643,512
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$870,641
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$5,017,560
Value of interest in pooled separate accounts at end of year2010-12-31$4,662,044
Interest on participant loans2010-12-31$1,849
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$27,227
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$59,839
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$59,839
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$12,913
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$108,490
Net investment gain/loss from pooled separate accounts2010-12-31$506,896
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$402,566
Employer contributions (assets) at end of year2010-12-31$264,234
Employer contributions (assets) at beginning of year2010-12-31$245,975
Income. Dividends from common stock2010-12-31$544
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$1,028,138
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$50,629
Assets. Corporate common stocks other than exployer securities at beginning of year2010-12-31$257,413
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31BAKER NEWMAN NOYES
Accountancy firm EIN2010-12-31010494526
2009 : CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN

2012: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: CENTRAL MAINE ORTHOPAEDICS, P.A. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87332
Policy instance 1
Insurance contract or identification number87332
Number of Individuals Covered94
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,935
Total amount of fees paid to insurance companyUSD $2,543
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $9,935
Insurance broker organization code?3
Amount paid for insurance broker fees2543
Additional information about fees paid to insurance brokerTPA ADMINISTRATOR ALLOWANCE
Insurance broker nameTHE ANGELL PENSION GROUP, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87332
Policy instance 1
Insurance contract or identification number87332
Number of Individuals Covered91
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,124
Total amount of fees paid to insurance companyUSD $2,280
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87332
Policy instance 1
Insurance contract or identification number87332
Number of Individuals Covered112
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $8,373
Total amount of fees paid to insurance companyUSD $2,407
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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

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