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GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 401k Plan overview

Plan NameGREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN
Plan identification number 002

GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM has sponsored the creation of one or more 401k plans.

Company Name:GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM
Employer identification number (EIN):391097670
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01LARRY LANGE2022-09-27
0022021-01-01LARRY LANGE2022-05-12
0022020-01-01ROBERT SERVAIS2021-07-12
0022019-01-01
0022018-01-01JOHN HANKES
0022017-01-01BRIAN JACOBSON
0022016-01-01BRIAN JACOBSON
0022015-01-01BRIAN JACOBSON
0022014-01-01JACK HANKES
0022013-01-01BRIAN JACOBSON
0022012-01-01JACK HANKES

Plan Statistics for GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN

401k plan membership statisitcs for GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN

Measure Date Value
2019: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0184
Total number of active participants reported on line 7a of the Form 55002019-01-0164
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0121
Total of all active and inactive participants2019-01-0185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0185
Number of participants with account balances2019-01-0162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0187
Total number of active participants reported on line 7a of the Form 55002018-01-0178
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-016
Total of all active and inactive participants2018-01-0184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0184
Number of participants with account balances2018-01-0158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0197
Total number of active participants reported on line 7a of the Form 55002017-01-0172
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0115
Total of all active and inactive participants2017-01-0187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0187
Number of participants with account balances2017-01-0170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0190
Total number of active participants reported on line 7a of the Form 55002016-01-0180
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0117
Total of all active and inactive participants2016-01-0197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0197
Number of participants with account balances2016-01-0176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0177
Total number of active participants reported on line 7a of the Form 55002015-01-0172
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0118
Total of all active and inactive participants2015-01-0190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0190
Number of participants with account balances2015-01-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0179
Total number of active participants reported on line 7a of the Form 55002014-01-0174
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0114
Total of all active and inactive participants2014-01-0188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0188
Number of participants with account balances2014-01-0170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0178
Total number of active participants reported on line 7a of the Form 55002013-01-0170
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-015
Total of all active and inactive participants2013-01-0175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0175
Number of participants with account balances2013-01-0168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0180
Total number of active participants reported on line 7a of the Form 55002012-01-0171
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-017
Total of all active and inactive participants2012-01-0178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0178
Number of participants with account balances2012-01-0167
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN

Measure Date Value
2019 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2019 401k financial data
Total income from all sources2019-12-31$143,463
Expenses. Total of all expenses incurred2019-12-31$91,636
Benefits paid (including direct rollovers)2019-12-31$78,969
Total plan assets at end of year2019-12-31$522,514
Total plan assets at beginning of year2019-12-31$470,687
Value of fidelity bond covering the plan2019-12-31$200,000
Total contributions received or receivable from participants2019-12-31$56,748
Other income received2019-12-31$86,621
Net income (gross income less expenses)2019-12-31$51,827
Net plan assets at end of year (total assets less liabilities)2019-12-31$522,514
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$470,687
Assets. Value of participant loans2019-12-31$9,170
Total contributions received or receivable from employer(s)2019-12-31$94
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$12,667
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2018 401k financial data
Total income from all sources2018-12-31$60,321
Expenses. Total of all expenses incurred2018-12-31$443,214
Benefits paid (including direct rollovers)2018-12-31$429,383
Total plan assets at end of year2018-12-31$470,687
Total plan assets at beginning of year2018-12-31$853,580
Value of fidelity bond covering the plan2018-12-31$200,000
Total contributions received or receivable from participants2018-12-31$66,526
Contributions received from other sources (not participants or employers)2018-12-31$10,033
Other income received2018-12-31$-17,121
Net income (gross income less expenses)2018-12-31$-382,893
Net plan assets at end of year (total assets less liabilities)2018-12-31$470,687
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$853,580
Assets. Value of participant loans2018-12-31$11,420
Total contributions received or receivable from employer(s)2018-12-31$883
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$13,831
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2017 401k financial data
Total income from all sources2017-12-31$228,962
Expenses. Total of all expenses incurred2017-12-31$182,835
Benefits paid (including direct rollovers)2017-12-31$172,733
Total plan assets at end of year2017-12-31$853,580
Total plan assets at beginning of year2017-12-31$807,453
Value of fidelity bond covering the plan2017-12-31$200,000
Total contributions received or receivable from participants2017-12-31$74,295
Contributions received from other sources (not participants or employers)2017-12-31$8,723
Other income received2017-12-31$101,827
Net income (gross income less expenses)2017-12-31$46,127
Net plan assets at end of year (total assets less liabilities)2017-12-31$853,580
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$807,453
Assets. Value of participant loans2017-12-31$15,841
Total contributions received or receivable from employer(s)2017-12-31$44,117
Value of corrective distributions2017-12-31$150
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$9,952
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2016 401k financial data
Total income from all sources2016-12-31$158,790
Expenses. Total of all expenses incurred2016-12-31$56,487
Benefits paid (including direct rollovers)2016-12-31$47,609
Total plan assets at end of year2016-12-31$807,453
Total plan assets at beginning of year2016-12-31$705,150
Value of fidelity bond covering the plan2016-12-31$200,000
Total contributions received or receivable from participants2016-12-31$76,561
Other income received2016-12-31$34,729
Net income (gross income less expenses)2016-12-31$102,303
Net plan assets at end of year (total assets less liabilities)2016-12-31$807,453
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$705,150
Assets. Value of participant loans2016-12-31$28,011
Total contributions received or receivable from employer(s)2016-12-31$47,500
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$8,878
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2015 401k financial data
Total income from all sources2015-12-31$113,236
Expenses. Total of all expenses incurred2015-12-31$225,384
Benefits paid (including direct rollovers)2015-12-31$217,220
Total plan assets at end of year2015-12-31$705,150
Total plan assets at beginning of year2015-12-31$817,298
Value of fidelity bond covering the plan2015-12-31$200,000
Total contributions received or receivable from participants2015-12-31$84,140
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$-19,524
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$-112,148
Net plan assets at end of year (total assets less liabilities)2015-12-31$705,150
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$817,298
Assets. Value of participant loans2015-12-31$6,714
Total contributions received or receivable from employer(s)2015-12-31$48,620
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$94
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$8,070
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2014 401k financial data
Total income from all sources2014-12-31$535,162
Expenses. Total of all expenses incurred2014-12-31$58,773
Benefits paid (including direct rollovers)2014-12-31$52,711
Total plan assets at end of year2014-12-31$817,298
Total plan assets at beginning of year2014-12-31$340,909
Value of fidelity bond covering the plan2014-12-31$200,000
Total contributions received or receivable from participants2014-12-31$98,993
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$367,423
Other income received2014-12-31$13,146
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$476,389
Net plan assets at end of year (total assets less liabilities)2014-12-31$817,298
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$340,909
Total contributions received or receivable from employer(s)2014-12-31$55,600
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$6,062
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2013 401k financial data
Total income from all sources2013-12-31$175,465
Expenses. Total of all expenses incurred2013-12-31$14,791
Benefits paid (including direct rollovers)2013-12-31$10,119
Total plan assets at end of year2013-12-31$340,909
Total plan assets at beginning of year2013-12-31$180,235
Value of fidelity bond covering the plan2013-12-31$200,000
Total contributions received or receivable from participants2013-12-31$100,817
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$2,208
Other income received2013-12-31$28,940
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$160,674
Net plan assets at end of year (total assets less liabilities)2013-12-31$340,909
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$180,235
Total contributions received or receivable from employer(s)2013-12-31$43,500
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$4,672
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2012 401k financial data
Total income from all sources2012-12-31$184,123
Expenses. Total of all expenses incurred2012-12-31$3,888
Benefits paid (including direct rollovers)2012-12-31$2,137
Total plan assets at end of year2012-12-31$180,235
Total plan assets at beginning of year2012-12-31$0
Total contributions received or receivable from participants2012-12-31$95,187
Contributions received from other sources (not participants or employers)2012-12-31$1,953
Other income received2012-12-31$4,026
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$180,235
Net plan assets at end of year (total assets less liabilities)2012-12-31$180,235
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$82,957
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$1,751
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0

Form 5500 Responses for GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN

2019: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT 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 – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT 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 filingNo
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 – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
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: GREEN VALLEY ENTERPRISES, INC. OF BEAVER DAM 401(K) RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104713
Policy instance 1
Insurance contract or identification number104713
Number of Individuals Covered62
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $426
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?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
Amount paid for insurance broker fees426
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104713
Policy instance 1
Insurance contract or identification number104713
Number of Individuals Covered79
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,040
Total amount of fees paid to insurance companyUSD $3,023
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?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 $3,040
Insurance broker organization code?7
Amount paid for insurance broker fees3023
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104713
Policy instance 1
Insurance contract or identification number104713
Number of Individuals Covered80
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,597
Total amount of fees paid to insurance companyUSD $1,866
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?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 $4,597
Insurance broker organization code?7
Amount paid for insurance broker fees1866
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker namePPG RETIREMENT PLAN SERVICES LTD

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