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DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 401k Plan overview

Plan NameDAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN
Plan identification number 001

DAVID M. DIAZ, D.D.S. 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.
  • Plan covering Self-Employed individuals.
  • 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

DAVID M. DIAZ, D.D.S. has sponsored the creation of one or more 401k plans.

Company Name:DAVID M. DIAZ, D.D.S.
Employer identification number (EIN):330443332
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012018-01-01DAVID M DIAZ, DDS2019-09-18
0012017-01-01
0012016-01-01DAVID DIAZ
0012015-01-01DAVID DIAZ
0012014-01-01DAVID DIAZ
0012013-01-01DAVID DIAZ
0012012-01-01DAVID DIAZ
0012011-01-01DAVID DIAZ
0012009-01-01DAVID DIAZ

Plan Statistics for DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN

401k plan membership statisitcs for DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN

Measure Date Value
2018: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-010
Number of participants with account balances2018-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011
Total number of active participants reported on line 7a of the Form 55002017-01-011
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-011
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-011
Number of participants with account balances2017-01-011
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-013
Total number of active participants reported on line 7a of the Form 55002016-01-011
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 participants2016-01-011
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: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-013
Total number of active participants reported on line 7a of the Form 55002015-01-011
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 participants2015-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-013
Number of participants with account balances2015-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-013
Total number of active participants reported on line 7a of the Form 55002014-01-011
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-012
Total of all active and inactive participants2014-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-013
Number of participants with account balances2014-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0110
Total number of active participants reported on line 7a of the Form 55002013-01-011
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-012
Total of all active and inactive participants2013-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-013
Number of participants with account balances2013-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0110
Total number of active participants reported on line 7a of the Form 55002012-01-0111
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0111
Number of participants with account balances2012-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0110
Total number of active participants reported on line 7a of the Form 55002011-01-0110
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0110
Number of participants with account balances2011-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0116
Total number of active participants reported on line 7a of the Form 55002009-01-019
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-011
Total of all active and inactive participants2009-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0110
Number of participants with account balances2009-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN

Measure Date Value
2018 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$-4,968
Expenses. Total of all expenses incurred2018-12-31$494,835
Benefits paid (including direct rollovers)2018-12-31$493,176
Total plan assets at end of year2018-12-31$0
Total plan assets at beginning of year2018-12-31$499,803
Value of fidelity bond covering the plan2018-12-31$50,000
Expenses. Other expenses not covered elsewhere2018-12-31$1,659
Other income received2018-12-31$-4,968
Net income (gross income less expenses)2018-12-31$-499,803
Net plan assets at end of year (total assets less liabilities)2018-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$499,803
Assets. Value of assets in partnership/joint-venture interests2018-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$26,805
Expenses. Total of all expenses incurred2017-12-31$360
Total plan assets at end of year2017-12-31$499,803
Total plan assets at beginning of year2017-12-31$473,358
Value of fidelity bond covering the plan2017-12-31$30,000
Total contributions received or receivable from participants2017-12-31$21,750
Expenses. Other expenses not covered elsewhere2017-12-31$360
Other income received2017-12-31$5,055
Net income (gross income less expenses)2017-12-31$26,445
Net plan assets at end of year (total assets less liabilities)2017-12-31$499,803
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$473,358
Assets. Value of assets in partnership/joint-venture interests2017-12-31$432,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$36,294
Expenses. Total of all expenses incurred2016-12-31$383,943
Benefits paid (including direct rollovers)2016-12-31$381,977
Total plan assets at end of year2016-12-31$473,358
Total plan assets at beginning of year2016-12-31$821,007
Value of fidelity bond covering the plan2016-12-31$30,000
Total contributions received or receivable from participants2016-12-31$0
Expenses. Other expenses not covered elsewhere2016-12-31$0
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$19,044
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$-347,649
Net plan assets at end of year (total assets less liabilities)2016-12-31$473,358
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$821,007
Assets. Value of assets in partnership/joint-venture interests2016-12-31$432,000
Total contributions received or receivable from employer(s)2016-12-31$17,250
Value of certain deemed distributions of participant loans2016-12-31$0
Value of corrective distributions2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$1,966
2015 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total income from all sources2015-12-31$5,309
Expenses. Total of all expenses incurred2015-12-31$3,711
Benefits paid (including direct rollovers)2015-12-31$0
Total plan assets at end of year2015-12-31$821,007
Total plan assets at beginning of year2015-12-31$819,409
Value of fidelity bond covering the plan2015-12-31$30,000
Total contributions received or receivable from participants2015-12-31$0
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$-5,191
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$1,598
Net plan assets at end of year (total assets less liabilities)2015-12-31$821,007
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$819,409
Assets. Value of assets in partnership/joint-venture interests2015-12-31$432,000
Total contributions received or receivable from employer(s)2015-12-31$10,500
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$3,711
2014 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$16,732
Expenses. Total of all expenses incurred2014-12-31$3,691
Benefits paid (including direct rollovers)2014-12-31$0
Total plan assets at end of year2014-12-31$819,409
Total plan assets at beginning of year2014-12-31$806,368
Value of fidelity bond covering the plan2014-12-31$30,000
Total contributions received or receivable from participants2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$16,732
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$13,041
Net plan assets at end of year (total assets less liabilities)2014-12-31$819,409
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$806,368
Assets. Value of assets in partnership/joint-venture interests2014-12-31$432,000
Total contributions received or receivable from employer(s)2014-12-31$0
Value of certain deemed distributions of participant loans2014-12-31$3,691
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$0
2013 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
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$41,595
Expenses. Total of all expenses incurred2013-12-31$169,383
Benefits paid (including direct rollovers)2013-12-31$165,367
Total plan assets at end of year2013-12-31$806,368
Total plan assets at beginning of year2013-12-31$934,156
Value of fidelity bond covering the plan2013-12-31$30,000
Expenses. Other expenses not covered elsewhere2013-12-31$0
Other income received2013-12-31$41,595
Net income (gross income less expenses)2013-12-31$-127,788
Net plan assets at end of year (total assets less liabilities)2013-12-31$806,368
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$934,156
Assets. Value of assets in partnership/joint-venture interests2013-12-31$432,000
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$4,016
2012 : DAVID M. DIAZ, D.D.S. PROFIT SHARING 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$252,921
Expenses. Total of all expenses incurred2012-12-31$9,303
Benefits paid (including direct rollovers)2012-12-31$2,452
Total plan assets at end of year2012-12-31$934,156
Total plan assets at beginning of year2012-12-31$690,538
Value of fidelity bond covering the plan2012-12-31$30,000
Total contributions received or receivable from participants2012-12-31$13,739
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$239,182
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$243,618
Net plan assets at end of year (total assets less liabilities)2012-12-31$934,156
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$690,538
Total contributions received or receivable from employer(s)2012-12-31$0
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$6,851
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
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$80,401
Expenses. Total of all expenses incurred2011-12-31$3,653
Total plan assets at end of year2011-12-31$690,538
Total plan assets at beginning of year2011-12-31$613,790
Value of fidelity bond covering the plan2011-12-31$30,000
Total contributions received or receivable from participants2011-12-31$26,900
Other income received2011-12-31$-8,621
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$76,748
Net plan assets at end of year (total assets less liabilities)2011-12-31$690,538
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$613,790
Total contributions received or receivable from employer(s)2011-12-31$62,122
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$3,653
2010 : DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
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$132,853
Expenses. Total of all expenses incurred2010-12-31$2,847
Benefits paid (including direct rollovers)2010-12-31$0
Total plan assets at end of year2010-12-31$613,790
Total plan assets at beginning of year2010-12-31$483,784
Value of fidelity bond covering the plan2010-12-31$30,000
Total contributions received or receivable from participants2010-12-31$26,400
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$45,138
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$130,006
Net plan assets at end of year (total assets less liabilities)2010-12-31$613,790
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$483,784
Total contributions received or receivable from employer(s)2010-12-31$61,315
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$2,847
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : DAVID M. DIAZ, D.D.S. 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 DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN

2018: DAVID M. DIAZ, D.D.S. PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingYes
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: DAVID M. DIAZ, D.D.S. 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 - TrustYes
2016: DAVID M. DIAZ, D.D.S. 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: DAVID M. DIAZ, D.D.S. 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: DAVID M. DIAZ, D.D.S. 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: DAVID M. DIAZ, D.D.S. 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: DAVID M. DIAZ, D.D.S. 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: DAVID M. DIAZ, D.D.S. 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
2009: DAVID M. DIAZ, D.D.S. 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 number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered0
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $355
Total amount of fees paid to insurance companyUSD $18
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
Commission paid to Insurance BrokerUSD $355
Insurance broker organization code?3
Amount paid for insurance broker fees18
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $112
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?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 $112
Insurance broker organization code?3
Insurance broker nameTHOMAS C. SIMONEK
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered3
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,359
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $1,359
Insurance broker organization code?3
Insurance broker nameTHOMAS C. SIMONEK
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered3
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,344
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $1,344
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTHOMAS C. SIMONEK
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,415
Total amount of fees paid to insurance companyUSD $250
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $1,415
Amount paid for insurance broker fees250
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
Insurance broker nameTHOMAS C. SIMONEK
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered7
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,509
Total amount of fees paid to insurance companyUSD $210
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $1,509
Amount paid for insurance broker fees210
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
Insurance broker nameTHOMAS C. SIMONEK
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered8
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,314
Total amount of fees paid to insurance companyUSD $35
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number29953
Policy instance 1
Insurance contract or identification number29953
Number of Individuals Covered8
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $966
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $966
Insurance broker organization code?5
Insurance broker nameTHOMAS C. SIMONEK

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