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WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameWILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST
Plan identification number 001

WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST Benefits

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

WILLIAM MICHAEL FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name:WILLIAM MICHAEL FOODS, INC.
Employer identification number (EIN):383461256
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-01-01CYNTHIA HEFNER
0012016-01-01CYNTHIA HEFNER
0012015-01-01CYNTHIA HEFNER
0012014-01-01CYNTHIA HEFNER
0012013-01-01CYNTHIA HEFNER
0012012-01-01CYNTHIA HEFNER
0012011-01-01CYNTHIA HEFNER
0012010-01-01CYNTHIA HEFNER
0012009-01-01CYNTHIA HEFNER

Plan Statistics for WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST

Measure Date Value
2017: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-014
Total number of active participants reported on line 7a of the Form 55002017-01-010
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 participants2017-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-010
Number of participants with account balances2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-0147
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 benefits2016-01-014
Total of all active and inactive participants2016-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-014
Number of participants with account balances2016-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-0151
Total number of active participants reported on line 7a of the Form 55002015-01-0135
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 participants2015-01-0137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0137
Number of participants with account balances2015-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0139
Total number of active participants reported on line 7a of the Form 55002014-01-0135
Number of retired or separated participants receiving benefits2014-01-011
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0136
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: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0144
Total number of active participants reported on line 7a of the Form 55002013-01-0137
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 participants2013-01-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0139
Number of participants with account balances2013-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-0139
Total number of active participants reported on line 7a of the Form 55002012-01-0136
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0139
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: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0121
Total number of active participants reported on line 7a of the Form 55002011-01-0121
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 participants2011-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0121
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: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-0122
Total number of active participants reported on line 7a of the Form 55002010-01-0121
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0121
Number of participants with account balances2010-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0122
Total number of active participants reported on line 7a of the Form 55002009-01-0120
Number of other retired or separated participants entitled to future benefits2009-01-012
Total of all active and inactive participants2009-01-0122
Total participants2009-01-0122
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 WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST

Measure Date Value
2017 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total income from all sources2017-01-10$41
Expenses. Total of all expenses incurred2017-01-10$434
Benefits paid (including direct rollovers)2017-01-10$434
Total plan assets at end of year2017-01-10$0
Total plan assets at beginning of year2017-01-10$393
Value of fidelity bond covering the plan2017-01-10$50,000
Other income received2017-01-10$41
Net income (gross income less expenses)2017-01-10$-393
Net plan assets at end of year (total assets less liabilities)2017-01-10$0
Net plan assets at beginning of year (total assets less liabilities)2017-01-10$393
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-01-10$0
2016 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2016 401k financial data
Total income from all sources2016-12-31$12,163
Expenses. Total of all expenses incurred2016-12-31$327,637
Benefits paid (including direct rollovers)2016-12-31$327,367
Total plan assets at end of year2016-12-31$393
Total plan assets at beginning of year2016-12-31$315,867
Value of fidelity bond covering the plan2016-12-31$50,000
Total contributions received or receivable from participants2016-12-31$350
Assets. Value of loans (other than to participants)2016-12-31$0
Other income received2016-12-31$11,813
Net income (gross income less expenses)2016-12-31$-315,474
Net plan assets at end of year (total assets less liabilities)2016-12-31$393
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$315,867
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$270
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-12-31$15,923
Expenses. Total of all expenses incurred2015-12-31$65,646
Benefits paid (including direct rollovers)2015-12-31$65,000
Total plan assets at end of year2015-12-31$315,867
Total plan assets at beginning of year2015-12-31$365,590
Value of fidelity bond covering the plan2015-12-31$40,000
Assets. Value of loans (other than to participants)2015-12-31$251,970
Other income received2015-12-31$13,463
Net income (gross income less expenses)2015-12-31$-49,723
Net plan assets at end of year (total assets less liabilities)2015-12-31$315,867
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$365,590
Total contributions received or receivable from employer(s)2015-12-31$2,460
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$646
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-12-31$18,963
Expenses. Total of all expenses incurred2014-12-31$44,456
Benefits paid (including direct rollovers)2014-12-31$43,596
Total plan assets at end of year2014-12-31$365,590
Total plan assets at beginning of year2014-12-31$391,083
Value of fidelity bond covering the plan2014-12-31$36,869
Total contributions received or receivable from participants2014-12-31$2,376
Assets. Value of loans (other than to participants)2014-12-31$282,899
Other income received2014-12-31$16,587
Net income (gross income less expenses)2014-12-31$-25,493
Net plan assets at end of year (total assets less liabilities)2014-12-31$365,590
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$391,083
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$860
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total income from all sources2013-12-31$23,307
Expenses. Total of all expenses incurred2013-12-31$905
Total plan assets at end of year2013-12-31$391,083
Total plan assets at beginning of year2013-12-31$368,681
Value of fidelity bond covering the plan2013-12-31$36,869
Total contributions received or receivable from participants2013-12-31$2,484
Assets. Value of loans (other than to participants)2013-12-31$364,352
Expenses. Other expenses not covered elsewhere2013-12-31$4
Other income received2013-12-31$20,823
Net income (gross income less expenses)2013-12-31$22,402
Net plan assets at end of year (total assets less liabilities)2013-12-31$391,083
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$368,681
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$901
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Total income from all sources2012-12-31$-21,816
Expenses. Total of all expenses incurred2012-12-31$3,311
Benefits paid (including direct rollovers)2012-12-31$2,485
Total plan assets at end of year2012-12-31$368,681
Total plan assets at beginning of year2012-12-31$393,808
Value of fidelity bond covering the plan2012-12-31$10,000
Total contributions received or receivable from participants2012-12-31$2,392
Other income received2012-12-31$-24,806
Net income (gross income less expenses)2012-12-31$-25,127
Net plan assets at end of year (total assets less liabilities)2012-12-31$368,681
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$393,808
Total contributions received or receivable from employer(s)2012-12-31$598
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$826
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Total income from all sources2011-12-31$1,972
Expenses. Total of all expenses incurred2011-12-31$848
Total plan assets at end of year2011-12-31$393,808
Total plan assets at beginning of year2011-12-31$392,684
Value of fidelity bond covering the plan2011-12-31$10,000
Total contributions received or receivable from participants2011-12-31$2,392
Other income received2011-12-31$-420
Net income (gross income less expenses)2011-12-31$1,124
Net plan assets at end of year (total assets less liabilities)2011-12-31$393,808
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$392,684
Assets. Value of employer securities2011-12-31$375,707
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$848
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Total income from all sources2010-12-31$4,291
Expenses. Total of all expenses incurred2010-12-31$2,204
Benefits paid (including direct rollovers)2010-12-31$1,390
Total plan assets at end of year2010-12-31$392,684
Total plan assets at beginning of year2010-12-31$390,597
Value of fidelity bond covering the plan2010-12-31$10,000
Total contributions received or receivable from participants2010-12-31$2,392
Other income received2010-12-31$1,899
Net income (gross income less expenses)2010-12-31$2,087
Net plan assets at end of year (total assets less liabilities)2010-12-31$392,684
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$390,597
Assets. Value of employer securities2010-12-31$375,707
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$814
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 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 WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST

2017: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 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 filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 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: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 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: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 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: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 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: WILLIAM MICHAEL FOODS, INC. 401K PROFIT SHARING PLAN AND TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number18269
Policy instance 1
Insurance contract or identification number18269
Number of Individuals Covered3
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $111
Total amount of fees paid to insurance companyUSD $7
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $111
Insurance broker organization code?3
Amount paid for insurance broker fees7
Additional information about fees paid to insurance brokerTPA FORUM COMPENSATION PAID BY JOHN HANCOCK NOT FROM PLAN ASSETS
Insurance broker nameKDP RETIREMENT PLAN SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number18269
Policy instance 1
Insurance contract or identification number18269
Number of Individuals Covered3
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $156
Total amount of fees paid to insurance companyUSD $27
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $156
Insurance broker organization code?3
Amount paid for insurance broker fees27
Additional information about fees paid to insurance brokerTPA FORUM COMPENSATION PAID BY JOHN HANCOCK NOT FROM PLAN ASSETS
Insurance broker nameKDP RETIREMENT PLAN SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number18269
Policy instance 1
Insurance contract or identification number18269
Number of Individuals Covered4
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $155
Total amount of fees paid to insurance companyUSD $10
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $155
Insurance broker organization code?3
Amount paid for insurance broker fees10
Additional information about fees paid to insurance brokerTPA FORUM COMPENSATION PAID BY JOHN HANCOCK NOT FROM PLAN ASSETS
Insurance broker nameKDP RETIREMENT PLAN SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number18269
Policy instance 1
Insurance contract or identification number18269
Number of Individuals Covered4
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $141
Total amount of fees paid to insurance companyUSD $41
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $141
Insurance broker organization code?3
Amount paid for insurance broker fees41
Additional information about fees paid to insurance brokerTPA FORUM COMPENSATION PAID BY JOHN HANCOCK NOT FROM PLAN ASSETS
Insurance broker nameKDP RETIREMENT PLAN SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number18269
Policy instance 1
Insurance contract or identification number18269
Number of Individuals Covered5
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $140
Total amount of fees paid to insurance companyUSD $31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number18269
Policy instance 1
Insurance contract or identification number18269
Number of Individuals Covered5
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $119
Total amount of fees paid to insurance companyUSD $7
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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