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INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 401k Plan overview

Plan NameINFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN
Plan identification number 001

INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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

INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. has sponsored the creation of one or more 401k plans.

Company Name:INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C.
Employer identification number (EIN):391683161
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01NANCY KWIATKOWSKI2023-09-22
0012021-01-01NANCY KWIATKOWSKI2022-04-22
0012020-01-01NANCY KWIATKOWSKI2021-05-12
0012019-01-01NANCY KWIATKOWSKI2020-08-28
0012018-01-01NANCY KWIATKOWSKI2019-08-27
0012017-01-01NANCY KWIATKOWSKI
0012016-01-01NANCY KWIATKOWSKI
0012015-01-01NANCY KWIATKOWSKI
0012014-01-01NANCY KWIATKOWSKI
0012013-01-01NANCY KWIATKOWSKI
0012012-01-01NANCY KWIATKOWSKI
0012011-01-01NANCY LANSER
0012009-01-01NANCY LANSER

Plan Statistics for INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN

401k plan membership statisitcs for INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN

Measure Date Value
2017: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0123
Total number of active participants reported on line 7a of the Form 55002017-01-0129
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 participants2017-01-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0129
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: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0125
Total number of active participants reported on line 7a of the Form 55002016-01-0124
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 participants2016-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0128
Number of participants with account balances2016-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-012
2015: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0125
Total number of active participants reported on line 7a of the Form 55002015-01-0123
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 participants2015-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0125
Number of participants with account balances2015-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-012
2014: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0123
Total number of active participants reported on line 7a of the Form 55002014-01-0123
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 participants2014-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0125
Number of participants with account balances2014-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
2013: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0118
Total number of active participants reported on line 7a of the Form 55002013-01-0118
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 participants2013-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0123
Number of participants with account balances2013-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0118
Total number of active participants reported on line 7a of the Form 55002012-01-0115
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 participants2012-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0118
Number of participants with account balances2012-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0120
Total number of active participants reported on line 7a of the Form 55002011-01-0115
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0118
Number of participants with account balances2011-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2009: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0115
Total of all active and inactive participants2009-01-010
Total participants2009-01-010

Financial Data on INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN

Measure Date Value
2017 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2017 401k financial data
Total income from all sources2017-12-31$1,312,331
Expenses. Total of all expenses incurred2017-12-31$149,579
Benefits paid (including direct rollovers)2017-12-31$108,415
Total plan assets at end of year2017-12-31$7,016,149
Total plan assets at beginning of year2017-12-31$5,853,397
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$144,727
Contributions received from other sources (not participants or employers)2017-12-31$87,894
Other income received2017-12-31$927,204
Net income (gross income less expenses)2017-12-31$1,162,752
Net plan assets at end of year (total assets less liabilities)2017-12-31$7,016,149
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$5,853,397
Assets. Value of participant loans2017-12-31$6,675
Total contributions received or receivable from employer(s)2017-12-31$152,506
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$41,164
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2016 401k financial data
Total income from all sources2016-12-31$734,092
Expenses. Total of all expenses incurred2016-12-31$59,627
Benefits paid (including direct rollovers)2016-12-31$20,602
Total plan assets at end of year2016-12-31$5,853,397
Total plan assets at beginning of year2016-12-31$5,178,932
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$160,575
Contributions received from other sources (not participants or employers)2016-12-31$107,834
Other income received2016-12-31$309,595
Net income (gross income less expenses)2016-12-31$674,465
Net plan assets at end of year (total assets less liabilities)2016-12-31$5,853,397
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$5,178,932
Total contributions received or receivable from employer(s)2016-12-31$156,088
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$39,025
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2015 401k financial data
Total income from all sources2015-12-31$398,919
Expenses. Total of all expenses incurred2015-12-31$68,389
Benefits paid (including direct rollovers)2015-12-31$6,728
Total plan assets at end of year2015-12-31$5,178,932
Total plan assets at beginning of year2015-12-31$4,848,402
Value of fidelity bond covering the plan2015-12-31$300,000
Total contributions received or receivable from participants2015-12-31$162,762
Contributions received from other sources (not participants or employers)2015-12-31$43,309
Other income received2015-12-31$8,529
Net income (gross income less expenses)2015-12-31$330,530
Net plan assets at end of year (total assets less liabilities)2015-12-31$5,178,932
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$4,848,402
Total contributions received or receivable from employer(s)2015-12-31$184,319
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$61,661
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2014 401k financial data
Total income from all sources2014-12-31$528,852
Expenses. Total of all expenses incurred2014-12-31$56,665
Benefits paid (including direct rollovers)2014-12-31$20,771
Total plan assets at end of year2014-12-31$4,848,402
Total plan assets at beginning of year2014-12-31$4,376,215
Value of fidelity bond covering the plan2014-12-31$300,000
Total contributions received or receivable from participants2014-12-31$156,578
Other income received2014-12-31$224,685
Net income (gross income less expenses)2014-12-31$472,187
Net plan assets at end of year (total assets less liabilities)2014-12-31$4,848,402
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$4,376,215
Total contributions received or receivable from employer(s)2014-12-31$147,589
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$35,894
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2013 401k financial data
Total income from all sources2013-12-31$820,092
Expenses. Total of all expenses incurred2013-12-31$70,984
Benefits paid (including direct rollovers)2013-12-31$33,331
Total plan assets at end of year2013-12-31$4,376,215
Total plan assets at beginning of year2013-12-31$3,627,107
Value of fidelity bond covering the plan2013-12-31$300,000
Total contributions received or receivable from participants2013-12-31$126,960
Contributions received from other sources (not participants or employers)2013-12-31$2,305
Other income received2013-12-31$557,687
Net income (gross income less expenses)2013-12-31$749,108
Net plan assets at end of year (total assets less liabilities)2013-12-31$4,376,215
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$3,627,107
Total contributions received or receivable from employer(s)2013-12-31$133,140
Value of certain deemed distributions of participant loans2013-12-31$2,541
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$35,112
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2012 401k financial data
Total income from all sources2012-12-31$622,379
Expenses. Total of all expenses incurred2012-12-31$23,746
Total plan assets at end of year2012-12-31$3,627,107
Total plan assets at beginning of year2012-12-31$3,028,474
Value of fidelity bond covering the plan2012-12-31$300,000
Total contributions received or receivable from participants2012-12-31$123,036
Other income received2012-12-31$370,223
Net income (gross income less expenses)2012-12-31$598,633
Net plan assets at end of year (total assets less liabilities)2012-12-31$3,627,107
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$3,028,474
Assets. Value of participant loans2012-12-31$2,595
Total contributions received or receivable from employer(s)2012-12-31$129,120
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$23,746
2011 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2011 401k financial data
Total income from all sources2011-12-31$250,530
Expenses. Total of all expenses incurred2011-12-31$90,934
Benefits paid (including direct rollovers)2011-12-31$66,702
Total plan assets at end of year2011-12-31$3,028,474
Total plan assets at beginning of year2011-12-31$2,868,878
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$121,433
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$5,492
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$159,596
Net plan assets at end of year (total assets less liabilities)2011-12-31$3,028,474
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$2,868,878
Assets. Value of participant loans2011-12-31$3,201
Total contributions received or receivable from employer(s)2011-12-31$123,605
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$24,232
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2010 401k financial data
Total income from all sources2010-12-31$581,014
Expenses. Total of all expenses incurred2010-12-31$35,147
Benefits paid (including direct rollovers)2010-12-31$13,714
Total plan assets at end of year2010-12-31$2,868,878
Total plan assets at beginning of year2010-12-31$2,323,011
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$123,088
Other income received2010-12-31$319,701
Net income (gross income less expenses)2010-12-31$545,867
Net plan assets at end of year (total assets less liabilities)2010-12-31$2,868,878
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$2,323,011
Total contributions received or receivable from employer(s)2010-12-31$138,225
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$21,433
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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 INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN

2017: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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 – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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 – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: INFECTIOUS DISEASE SPECIALISTS OF S.E. WI, S.C. 401K 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 number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,062
Total amount of fees paid to insurance companyUSD $672
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 $1,569
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?7
Insurance broker namePPG RETIREMENT PLAN SERVICES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered20
Insurance policy start date2016-01-01
Insurance policy end date2016-12-31
Total amount of commissions paid to insurance brokerUSD $2,775
Total amount of fees paid to insurance companyUSD $793
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 $2,775
Insurance broker organization code?7
Amount paid for insurance broker fees793
Additional information about fees paid to insurance brokerTPA SERVICES
Insurance broker namePPG RETIREMENT PLAN SERVICES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered22
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,414
Total amount of fees paid to insurance companyUSD $545
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 $2,414
Insurance broker organization code?7
Amount paid for insurance broker fees545
Additional information about fees paid to insurance brokerTPA SERVICES
Insurance broker namePPG RETIREMENT PLAN SERVICES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered15
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,113
Total amount of fees paid to insurance companyUSD $616
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 $2,113
Insurance broker organization code?7
Amount paid for insurance broker fees616
Additional information about fees paid to insurance brokerTPA SERVICES
Insurance broker namePPG RETIREMENT PLAN SERVICES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered17
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,679
Total amount of fees paid to insurance companyUSD $396
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 $1,679
Insurance broker organization code?7
Amount paid for insurance broker fees396
Additional information about fees paid to insurance brokerTPA SERVICES
Insurance broker namePPG RETIREMENT PLAN SERVICES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered18
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,340
Total amount of fees paid to insurance companyUSD $270
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 $1,340
Insurance broker organization code?7
Amount paid for insurance broker fees270
Additional information about fees paid to insurance brokerTPA SERVICES
Insurance broker namePPG RETIREMENT PLAN SERVICES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered18
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,139
Total amount of fees paid to insurance companyUSD $451
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 number87612
Policy instance 1
Insurance contract or identification number87612
Number of Individuals Covered14
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $946
Total amount of fees paid to insurance companyUSD $438
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 $946
Insurance broker organization code?7
Amount paid for insurance broker fees438
Additional information about fees paid to insurance brokerTPA SERVICES
Insurance broker namePPG RETIREMENT PLAN SERVICES

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