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THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameTHE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN
Plan identification number 001

THE OPTOMETRISTS, P.C. 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.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

THE OPTOMETRISTS, P.C. has sponsored the creation of one or more 401k plans.

Company Name:THE OPTOMETRISTS, P.C.
Employer identification number (EIN):202028919
NAIC Classification:621320
NAIC Description:Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01RUSSELL BRODY2024-06-28
0012022-01-01RUSSELL BRODY2023-07-06
0012021-01-01RONALD HENDERSON2022-04-29
0012020-01-01RONALD HENDERSON2021-06-15
0012019-01-01RONALD HENDERSON2020-07-15
0012018-01-01RONALD HENDERSON2019-09-12
0012017-01-01RONALD HENDERSON
0012016-01-01RONALD HENDERSON
0012015-01-01RONALD HENDERSON
0012014-01-01RONALD HENDERSON
0012013-01-01RONALD HENDERSON
0012012-01-01RONALD HENDERSON2013-07-19
0012011-01-01RONALD HENDERSON2012-07-18
0012010-01-01RONALD HENDERSON
0012009-01-01RONALD HENDERSON
0012009-01-01RONALD HENDERSON

Plan Statistics for THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2017: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0121
Total number of active participants reported on line 7a of the Form 55002017-01-0113
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0119
Number of participants with account balances2017-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-012
2016: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0121
Total number of active participants reported on line 7a of the Form 55002016-01-0114
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-016
Total of all active and inactive participants2016-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0120
Number of participants with account balances2016-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-012
2015: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0120
Total number of active participants reported on line 7a of the Form 55002015-01-0115
Number of retired or separated participants receiving benefits2015-01-012
Number of other retired or separated participants entitled to future benefits2015-01-014
Total of all active and inactive participants2015-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0121
Number of participants with account balances2015-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0121
Total number of active participants reported on line 7a of the Form 55002014-01-0116
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-014
Total of all active and inactive participants2014-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0120
Number of participants with account balances2014-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0121
Total number of active participants reported on line 7a of the Form 55002013-01-0116
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-014
Total of all active and inactive participants2013-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0120
Number of participants with account balances2013-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2010: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0119
Total number of active participants reported on line 7a of the Form 55002010-01-0113
Number of retired or separated participants receiving benefits2010-01-011
Number of other retired or separated participants entitled to future benefits2010-01-015
Total of all active and inactive participants2010-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0119
Number of participants with account balances2010-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0119
Total number of active participants reported on line 7a of the Form 55002009-01-0114
Number of retired or separated participants receiving benefits2009-01-011
Number of other retired or separated participants entitled to future benefits2009-01-015
Total of all active and inactive participants2009-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0120
Number of participants with account balances2009-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2017 : THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$351,255
Expenses. Total of all expenses incurred2017-12-31$18,632
Benefits paid (including direct rollovers)2017-12-31$7,779
Total plan assets at end of year2017-12-31$1,582,413
Total plan assets at beginning of year2017-12-31$1,249,790
Value of fidelity bond covering the plan2017-12-31$750,000
Total contributions received or receivable from participants2017-12-31$71,441
Other income received2017-12-31$167,127
Net income (gross income less expenses)2017-12-31$332,623
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,582,413
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,249,790
Total contributions received or receivable from employer(s)2017-12-31$112,687
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$10,853
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$0
Total income from all sources2016-12-31$274,252
Expenses. Total of all expenses incurred2016-12-31$117,516
Benefits paid (including direct rollovers)2016-12-31$108,178
Total plan assets at end of year2016-12-31$1,249,790
Total plan assets at beginning of year2016-12-31$1,093,054
Value of fidelity bond covering the plan2016-12-31$750,000
Total contributions received or receivable from participants2016-12-31$67,370
Other income received2016-12-31$94,377
Net income (gross income less expenses)2016-12-31$156,736
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,249,790
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,093,054
Total contributions received or receivable from employer(s)2016-12-31$112,505
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$9,338
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$157,166
Expenses. Total of all expenses incurred2015-12-31$26,760
Benefits paid (including direct rollovers)2015-12-31$17,768
Total plan assets at end of year2015-12-31$1,093,054
Total plan assets at beginning of year2015-12-31$962,648
Value of fidelity bond covering the plan2015-12-31$750,000
Total contributions received or receivable from participants2015-12-31$63,316
Other income received2015-12-31$-24,089
Net income (gross income less expenses)2015-12-31$130,406
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,093,054
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$962,648
Total contributions received or receivable from employer(s)2015-12-31$117,939
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$8,992
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$141,559
Expenses. Total of all expenses incurred2014-12-31$9,140
Total plan assets at end of year2014-12-31$962,648
Total plan assets at beginning of year2014-12-31$830,229
Value of fidelity bond covering the plan2014-12-31$750,000
Total contributions received or receivable from participants2014-12-31$62,285
Other income received2014-12-31$53,144
Net income (gross income less expenses)2014-12-31$132,419
Net plan assets at end of year (total assets less liabilities)2014-12-31$962,648
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$830,229
Total contributions received or receivable from employer(s)2014-12-31$26,130
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$9,140
2013 : THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING 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$220,832
Expenses. Total of all expenses incurred2013-12-31$38,019
Benefits paid (including direct rollovers)2013-12-31$30,161
Total plan assets at end of year2013-12-31$830,229
Total plan assets at beginning of year2013-12-31$647,416
Value of fidelity bond covering the plan2013-12-31$750,000
Total contributions received or receivable from participants2013-12-31$59,239
Other income received2013-12-31$139,174
Net income (gross income less expenses)2013-12-31$182,813
Net plan assets at end of year (total assets less liabilities)2013-12-31$830,229
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$647,416
Total contributions received or receivable from employer(s)2013-12-31$22,419
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$7,858
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2010 : THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$104,998
Expenses. Total of all expenses incurred2010-12-31$28,089
Benefits paid (including direct rollovers)2010-12-31$28,089
Total plan assets at end of year2010-12-31$428,525
Total plan assets at beginning of year2010-12-31$351,616
Value of fidelity bond covering the plan2010-12-31$35,000
Total contributions received or receivable from participants2010-12-31$43,595
Other income received2010-12-31$47,194
Net income (gross income less expenses)2010-12-31$76,909
Net plan assets at end of year (total assets less liabilities)2010-12-31$428,525
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$351,616
Total contributions received or receivable from employer(s)2010-12-31$14,209
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : THE OPTOMETRISTS, P.C. 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 THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN

2017: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING 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 filingNo
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: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING 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: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING 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: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING 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
2010: THE OPTOMETRISTS, P.C. 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: THE OPTOMETRISTS, P.C. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
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 - 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 number19509
Policy instance 1
Insurance contract or identification number19509
Number of Individuals Covered20
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $648
Are there contracts with allocated funds for individual policies?0
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
Amount paid for insurance broker fees648
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
Insurance broker nameHUNTER BENEFITS CONSULTING GROUP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number19509
Policy instance 1
Insurance contract or identification number19509
Number of Individuals Covered17
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $931
Total amount of fees paid to insurance companyUSD $4,947
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 $931
Amount paid for insurance broker fees4462
Additional information about fees paid to insurance brokerRIA FEES PAID
Insurance broker organization code?3
Insurance broker nameHUNTER BENEFITS CONSULTING GROUP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number19509
Policy instance 1
Insurance contract or identification number19509
Number of Individuals Covered18
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,223
Total amount of fees paid to insurance companyUSD $437
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 $4,295
Insurance broker organization code?3
Amount paid for insurance broker fees437
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameHUNTER BENEFITS CONSULTING GROUP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number19509
Policy instance 1
Insurance contract or identification number19509
Number of Individuals Covered18
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,297
Total amount of fees paid to insurance companyUSD $359
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 $4,297
Insurance broker organization code?3
Amount paid for insurance broker fees359
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameHUNTER BENEFITS CONSULTING GROUP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract numberGP 19509
Policy instance 1
Insurance contract or identification numberGP 19509
Number of Individuals Covered14
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,213
Total amount of fees paid to insurance companyUSD $172
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?Yes
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?No
Commission paid to Insurance BrokerUSD $2,213
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees172
Insurance broker nameHUNTER BENEFITS CONSULTING GROUP

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