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WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 401k Plan overview

Plan NameWOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN
Plan identification number 002

WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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

WOMEN'S HEALTH ASSOCIATES, INC. has sponsored the creation of one or more 401k plans.

Company Name:WOMEN'S HEALTH ASSOCIATES, INC.
Employer identification number (EIN):042481061
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about WOMEN'S HEALTH ASSOCIATES, INC.

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division
Incorporation Date: 2010-12-16
Company Identification Number: 130982
Legal Registered Office Address: PO BOX 7

RANDOLPH
United States of America (USA)
05060

More information about WOMEN'S HEALTH ASSOCIATES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022016-01-01AUDREY EDMUNDS
0022015-01-01AUDREY EDMUNDS
0022014-01-01AUDREY EDMUNDS
0022013-01-01AUDREY EDMUNDS
0022012-01-01AUDREY EDMUNDS
0022011-01-01AUDREY EDMUNDS
0022009-01-01AUDREY EDMUNDS

Plan Statistics for WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN

401k plan membership statisitcs for WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN

Measure Date Value
2016: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0119
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-010
Number of participants with account balances2016-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0124
Total number of active participants reported on line 7a of the Form 55002015-01-0114
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-016
Total of all active and inactive participants2015-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0120
Number of participants with account balances2015-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0125
Total number of active participants reported on line 7a of the Form 55002014-01-0118
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-016
Total of all active and inactive participants2014-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0124
Number of participants with account balances2014-01-0120
2013: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0127
Total number of active participants reported on line 7a of the Form 55002013-01-0118
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-016
Total of all active and inactive participants2013-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0124
Number of participants with account balances2013-01-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0128
Total number of active participants reported on line 7a of the Form 55002012-01-0118
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-019
Total of all active and inactive participants2012-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0127
Number of participants with account balances2012-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0126
Total number of active participants reported on line 7a of the Form 55002011-01-0120
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-017
Total of all active and inactive participants2011-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0127
Number of participants with account balances2011-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0127
Total number of active participants reported on line 7a of the Form 55002009-01-0122
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-018
Total of all active and inactive participants2009-01-0130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0130
Number of participants with account balances2009-01-0127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN

Measure Date Value
2016 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2016 401k financial data
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$144,317
Expenses. Total of all expenses incurred2016-12-31$2,155,819
Benefits paid (including direct rollovers)2016-12-31$2,141,296
Total plan assets at end of year2016-12-31$0
Total plan assets at beginning of year2016-12-31$2,011,502
Value of fidelity bond covering the plan2016-12-31$325,000
Total contributions received or receivable from participants2016-12-31$55,326
Other income received2016-12-31$69,099
Net income (gross income less expenses)2016-12-31$-2,011,502
Net plan assets at end of year (total assets less liabilities)2016-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$2,011,502
Assets. Value of participant loans2016-12-31$0
Total contributions received or receivable from employer(s)2016-12-31$19,892
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$14,523
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$153,669
Expenses. Total of all expenses incurred2015-12-31$198,588
Benefits paid (including direct rollovers)2015-12-31$174,081
Total plan assets at end of year2015-12-31$2,011,502
Total plan assets at beginning of year2015-12-31$2,056,421
Value of fidelity bond covering the plan2015-12-31$325,000
Total contributions received or receivable from participants2015-12-31$122,889
Other income received2015-12-31$-25,372
Net income (gross income less expenses)2015-12-31$-44,919
Net plan assets at end of year (total assets less liabilities)2015-12-31$2,011,502
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$2,056,421
Assets. Value of participant loans2015-12-31$19,479
Total contributions received or receivable from employer(s)2015-12-31$56,152
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$24,507
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$274,748
Expenses. Total of all expenses incurred2014-12-31$216,171
Benefits paid (including direct rollovers)2014-12-31$191,856
Total plan assets at end of year2014-12-31$2,056,421
Total plan assets at beginning of year2014-12-31$1,997,844
Value of fidelity bond covering the plan2014-12-31$325,000
Total contributions received or receivable from participants2014-12-31$123,951
Other income received2014-12-31$91,508
Net income (gross income less expenses)2014-12-31$58,577
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,056,421
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,997,844
Assets. Value of participant loans2014-12-31$34,658
Total contributions received or receivable from employer(s)2014-12-31$59,289
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$24,315
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$467,423
Expenses. Total of all expenses incurred2013-12-31$309,240
Benefits paid (including direct rollovers)2013-12-31$286,243
Total plan assets at end of year2013-12-31$1,997,844
Total plan assets at beginning of year2013-12-31$1,839,661
Value of fidelity bond covering the plan2013-12-31$325,000
Total contributions received or receivable from participants2013-12-31$110,899
Other income received2013-12-31$299,690
Net income (gross income less expenses)2013-12-31$158,183
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,997,844
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,839,661
Assets. Value of participant loans2013-12-31$38,237
Total contributions received or receivable from employer(s)2013-12-31$56,834
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$22,997
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$379,604
Expenses. Total of all expenses incurred2012-12-31$27,531
Benefits paid (including direct rollovers)2012-12-31$6,917
Total plan assets at end of year2012-12-31$1,839,661
Total plan assets at beginning of year2012-12-31$1,487,588
Value of fidelity bond covering the plan2012-12-31$325,000
Total contributions received or receivable from participants2012-12-31$112,839
Other income received2012-12-31$209,950
Net income (gross income less expenses)2012-12-31$352,073
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,839,661
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,487,588
Assets. Value of participant loans2012-12-31$8,627
Total contributions received or receivable from employer(s)2012-12-31$56,815
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$20,614
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$125,034
Expenses. Total of all expenses incurred2011-12-31$126,704
Benefits paid (including direct rollovers)2011-12-31$108,123
Total plan assets at end of year2011-12-31$1,487,588
Total plan assets at beginning of year2011-12-31$1,489,258
Value of fidelity bond covering the plan2011-12-31$325,000
Total contributions received or receivable from participants2011-12-31$101,135
Other income received2011-12-31$-31,111
Net income (gross income less expenses)2011-12-31$-1,670
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,487,588
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,489,258
Assets. Value of participant loans2011-12-31$40,253
Total contributions received or receivable from employer(s)2011-12-31$55,010
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$18,581
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$337,075
Expenses. Total of all expenses incurred2010-12-31$40,665
Benefits paid (including direct rollovers)2010-12-31$23,740
Total plan assets at end of year2010-12-31$1,489,258
Total plan assets at beginning of year2010-12-31$1,192,848
Value of fidelity bond covering the plan2010-12-31$325,000
Total contributions received or receivable from participants2010-12-31$110,013
Contributions received from other sources (not participants or employers)2010-12-31$1,390
Other income received2010-12-31$171,269
Net income (gross income less expenses)2010-12-31$296,410
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,489,258
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,192,848
Assets. Value of participant loans2010-12-31$35,876
Total contributions received or receivable from employer(s)2010-12-31$54,403
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$16,925
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : WOMEN'S HEALTH ASSOCIATES, INC. 401(K) 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 WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN

2016: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) 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: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) 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
2009: WOMEN'S HEALTH ASSOCIATES, INC. 401(K) 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 number16780
Policy instance 1
Insurance contract or identification number16780
Number of Individuals Covered16
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $20,882
Total amount of fees paid to insurance companyUSD $1,052
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?No
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?Yes
Commission paid to Insurance BrokerUSD $20,882
Insurance broker organization code?3
Amount paid for insurance broker fees1052
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameSWERDLIN NORTHEAST LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number16780
Policy instance 1
Insurance contract or identification number16780
Number of Individuals Covered21
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $20,509
Total amount of fees paid to insurance companyUSD $1,131
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?No
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?Yes
Commission paid to Insurance BrokerUSD $20,509
Insurance broker organization code?3
Amount paid for insurance broker fees1031
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameSWERDLIN NORTHEAST LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number16780
Policy instance 1
Insurance contract or identification number16780
Number of Individuals Covered21
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $18,985
Total amount of fees paid to insurance companyUSD $1,153
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?No
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?Yes
Commission paid to Insurance BrokerUSD $18,985
Insurance broker organization code?3
Amount paid for insurance broker fees953
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePENRET SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number16780
Policy instance 1
Insurance contract or identification number16780
Number of Individuals Covered24
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $16,611
Total amount of fees paid to insurance companyUSD $833
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?No
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?Yes
Commission paid to Insurance BrokerUSD $16,611
Insurance broker organization code?3
Amount paid for insurance broker fees833
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePENRET SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number16780
Policy instance 1
Insurance contract or identification number16780
Number of Individuals Covered24
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $14,781
Total amount of fees paid to insurance companyUSD $835
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?No
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?Yes
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number16780
Policy instance 1
Insurance contract or identification number16780
Number of Individuals Covered25
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $12,721
Total amount of fees paid to insurance companyUSD $791
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?Yes
Commission paid to Insurance BrokerUSD $12,721
Insurance broker organization code?3
Amount paid for insurance broker fees791
Additional information about fees paid to insurance brokerTPA COMPENSATION AND TPA FEES PAID
Insurance broker namePENRET SERVICES, INC.

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