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HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 401k Plan overview

Plan NameHOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN
Plan identification number 001

HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • 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.
  • 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

HOUSE OF FLOORS OF SARASOTA, INC. has sponsored the creation of one or more 401k plans.

Company Name:HOUSE OF FLOORS OF SARASOTA, INC.
Employer identification number (EIN):300055915
NAIC Classification:238900

Additional information about HOUSE OF FLOORS OF SARASOTA, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2002-01-10
Company Identification Number: P02000005055
Legal Registered Office Address: 2280 TRAILMATE DRIVE

SARASOTA

34243

More information about HOUSE OF FLOORS OF SARASOTA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012020-01-01TARA SIMMONS2021-10-15
0012019-01-01TARA SIMMONS2020-10-15
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01
0012012-01-01TARA SIMMONS
0012011-01-01TARA SIMMONS
0012010-01-01TARA SIMMONS TARA SIMMONS2011-10-17
0012009-01-01TARA SIMMONS TARA SIMMONS2010-10-15

Plan Statistics for HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN

401k plan membership statisitcs for HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN

Measure Date Value
2020: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-011
Total of all active and inactive participants2020-01-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-011
Number of participants with account balances2020-01-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-011
Total of all active and inactive participants2019-01-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-011
Number of participants with account balances2019-01-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2016: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011
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 benefits2016-01-011
Total of all active and inactive participants2016-01-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-011
Number of participants with account balances2016-01-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-019
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-012
Total of all active and inactive participants2015-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-011
Total participants2015-01-013
Number of participants with account balances2015-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-015
Total number of active participants reported on line 7a of the Form 55002014-01-013
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-014
Number of participants with account balances2014-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-016
Total number of active participants reported on line 7a of the Form 55002013-01-014
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-015
Number of participants with account balances2013-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-019
Total number of active participants reported on line 7a of the Form 55002012-01-014
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-012
Total of all active and inactive participants2012-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-016
Number of participants with account balances2012-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-017
Total number of active participants reported on line 7a of the Form 55002011-01-015
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-012
Total of all active and inactive participants2011-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-017
Number of participants with account balances2011-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-015
Total number of active participants reported on line 7a of the Form 55002010-01-016
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-011
Total of all active and inactive participants2010-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-017
Number of participants with account balances2010-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-015
Total number of active participants reported on line 7a of the Form 55002009-01-016
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-016
Number of participants with account balances2009-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN

Measure Date Value
2020 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources2020-12-31$5,581
Expenses. Total of all expenses incurred2020-12-31$679
Total plan assets at end of year2020-12-31$50,503
Total plan assets at beginning of year2020-12-31$45,601
Other income received2020-12-31$5,581
Net income (gross income less expenses)2020-12-31$4,902
Net plan assets at end of year (total assets less liabilities)2020-12-31$50,503
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$45,601
Assets. Value of participant loans2020-12-31$24,363
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$679
2019 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources2019-12-31$5,720
Expenses. Total of all expenses incurred2019-12-31$651
Total plan assets at end of year2019-12-31$45,601
Total plan assets at beginning of year2019-12-31$40,532
Other income received2019-12-31$5,720
Net income (gross income less expenses)2019-12-31$5,069
Net plan assets at end of year (total assets less liabilities)2019-12-31$45,601
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$40,532
Assets. Value of participant loans2019-12-31$23,035
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$651
2016 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$2,751
Expenses. Total of all expenses incurred2016-12-31$459
Total plan assets at end of year2016-12-31$35,336
Total plan assets at beginning of year2016-12-31$33,044
Other income received2016-12-31$2,751
Net income (gross income less expenses)2016-12-31$2,292
Net plan assets at end of year (total assets less liabilities)2016-12-31$35,336
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$33,044
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$459
2015 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$307
Expenses. Total of all expenses incurred2015-12-31$35,257
Benefits paid (including direct rollovers)2015-12-31$34,490
Total plan assets at end of year2015-12-31$33,044
Total plan assets at beginning of year2015-12-31$67,994
Expenses. Other expenses not covered elsewhere2015-12-31$65
Other income received2015-12-31$307
Net income (gross income less expenses)2015-12-31$-34,950
Net plan assets at end of year (total assets less liabilities)2015-12-31$33,044
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$67,994
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$702
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$4,100
Expenses. Total of all expenses incurred2014-12-31$20,273
Benefits paid (including direct rollovers)2014-12-31$19,164
Total plan assets at end of year2014-12-31$67,994
Total plan assets at beginning of year2014-12-31$84,167
Expenses. Other expenses not covered elsewhere2014-12-31$130
Other income received2014-12-31$4,100
Net income (gross income less expenses)2014-12-31$-16,173
Net plan assets at end of year (total assets less liabilities)2014-12-31$67,994
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$84,167
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$979
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$14,351
Expenses. Total of all expenses incurred2013-12-31$336
Benefits paid (including direct rollovers)2013-12-31$336
Total plan assets at end of year2013-12-31$84,167
Total plan assets at beginning of year2013-12-31$70,152
Other income received2013-12-31$14,351
Net income (gross income less expenses)2013-12-31$14,015
Net plan assets at end of year (total assets less liabilities)2013-12-31$84,167
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$70,152
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$9,371
Expenses. Total of all expenses incurred2012-12-31$919
Total plan assets at end of year2012-12-31$70,152
Total plan assets at beginning of year2012-12-31$61,700
Other income received2012-12-31$9,371
Net income (gross income less expenses)2012-12-31$8,452
Net plan assets at end of year (total assets less liabilities)2012-12-31$70,152
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$61,700
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$919
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$-3,002
Expenses. Total of all expenses incurred2011-12-31$892
Total plan assets at end of year2011-12-31$61,700
Total plan assets at beginning of year2011-12-31$65,594
Other income received2011-12-31$-3,002
Net income (gross income less expenses)2011-12-31$-3,894
Net plan assets at end of year (total assets less liabilities)2011-12-31$61,700
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$65,594
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$892
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$8,859
Expenses. Total of all expenses incurred2010-12-31$1,087
Benefits paid (including direct rollovers)2010-12-31$232
Total plan assets at end of year2010-12-31$65,594
Total plan assets at beginning of year2010-12-31$57,822
Other income received2010-12-31$8,859
Net income (gross income less expenses)2010-12-31$7,772
Net plan assets at end of year (total assets less liabilities)2010-12-31$65,594
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$57,822
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$855
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : HOUSE OF FLOORS OF SARASOTA 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 HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN

2020: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: HOUSE OF FLOORS OF SARASOTA PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2016: HOUSE OF FLOORS OF SARASOTA 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 - TrustYes
2015: HOUSE OF FLOORS OF SARASOTA 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 - TrustYes
2014: HOUSE OF FLOORS OF SARASOTA 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 - TrustYes
2013: HOUSE OF FLOORS OF SARASOTA 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 - TrustYes
2012: HOUSE OF FLOORS OF SARASOTA 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 - TrustYes
2011: HOUSE OF FLOORS OF SARASOTA 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 - TrustYes
2010: HOUSE OF FLOORS OF SARASOTA 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 - TrustYes
2009: HOUSE OF FLOORS OF SARASOTA 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 - 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 number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered1
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $250
Total amount of fees paid to insurance companyUSD $0
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?Yes
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 $227
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $238
Total amount of fees paid to insurance companyUSD $0
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?Yes
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 $216
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $298
Total amount of fees paid to insurance companyUSD $65
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?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 $271
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameAMERICAN PENSION SERVICES, LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered2
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $402
Total amount of fees paid to insurance companyUSD $130
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 $365
Insurance broker organization code?3
Amount paid for insurance broker fees130
Additional information about fees paid to insurance brokerSALES/ADMINISTRATION
Insurance broker nameGENWORTH FINANCIAL SECURITIES CORP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered4
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $397
Total amount of fees paid to insurance companyUSD $88
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 $397
Insurance broker organization code?3
Amount paid for insurance broker fees88
Additional information about fees paid to insurance brokerSALES/ADMINISTRATION
Insurance broker nameGENWORTH FINANCIAL SECURITIES CORP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered4
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $333
Total amount of fees paid to insurance companyUSD $33
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 $333
Insurance broker organization code?3
Amount paid for insurance broker fees33
Additional information about fees paid to insurance brokerSALES/ADMINISTRATION
Insurance broker nameGENWORTH FINANCIAL SECURITIES CORP
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered4
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $328
Total amount of fees paid to insurance companyUSD $140
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number69547
Policy instance 1
Insurance contract or identification number69547
Number of Individuals Covered4
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $291
Total amount of fees paid to insurance companyUSD $160
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes

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