401k Plan data: CAMBRIDGE HOSPICE 401(K) PLAN plan

CAMBRIDGE HOSPICE 401(K) PLAN 401k Plan overview

Plan Name	CAMBRIDGE HOSPICE 401(K) PLAN
Plan identification number	001

CAMBRIDGE HOSPICE 401(K) PLAN Benefits

401k Plan Type

Defined 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

CAMBRIDGE HOSPICE has sponsored the creation of one or more 401k plans.

Company Name: CAMBRIDGE HOSPICE

Employer identification number (EIN): 453481847

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAMBRIDGE HOSPICE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01
001 2018-01-01
001 2017-01-01 FELISA MARTIN FELISA MARTIN 2018-10-15
001 2016-01-01 FELISA MARTIN FELISA MARTIN 2017-10-12
001 2015-01-01 FELISA MARTIN FELISA MARTIN 2016-10-15
001 2014-01-01 SHARON WAKE FELISA MARTIN 2015-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01
001	2018-01-01
001	2017-01-01	FELISA MARTIN	FELISA MARTIN	2018-10-15
001	2016-01-01	FELISA MARTIN	FELISA MARTIN	2017-10-12
001	2015-01-01	FELISA MARTIN	FELISA MARTIN	2016-10-15
001	2014-01-01	SHARON WAKE	FELISA MARTIN	2015-10-14

Plan Statistics for CAMBRIDGE HOSPICE 401(K) PLAN

401k plan membership statisitcs for CAMBRIDGE HOSPICE 401(K) PLAN

Measure Date Value
2019: CAMBRIDGE HOSPICE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CAMBRIDGE HOSPICE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 115
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 1
Total of all active and inactive participants 2018-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 116
Number of participants with account balances 2018-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CAMBRIDGE HOSPICE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 134
Number of retired or separated participants receiving benefits 2017-01-01 6
Number of other retired or separated participants entitled to future benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 145
Number of participants with account balances 2017-01-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: CAMBRIDGE HOSPICE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 121
Number of retired or separated participants receiving benefits 2016-01-01 4
Number of other retired or separated participants entitled to future benefits 2016-01-01 12
Total of all active and inactive participants 2016-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 137
Number of participants with account balances 2016-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CAMBRIDGE HOSPICE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 105
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 13
Total of all active and inactive participants 2015-01-01 118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 118
Number of participants with account balances 2015-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CAMBRIDGE HOSPICE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 118
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 120
Number of participants with account balances 2014-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2019: CAMBRIDGE HOSPICE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CAMBRIDGE HOSPICE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	115
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	1
Total of all active and inactive participants	2018-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	116
Number of participants with account balances	2018-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CAMBRIDGE HOSPICE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	134
Number of retired or separated participants receiving benefits	2017-01-01	6
Number of other retired or separated participants entitled to future benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	145
Number of participants with account balances	2017-01-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: CAMBRIDGE HOSPICE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	121
Number of retired or separated participants receiving benefits	2016-01-01	4
Number of other retired or separated participants entitled to future benefits	2016-01-01	12
Total of all active and inactive participants	2016-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	137
Number of participants with account balances	2016-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CAMBRIDGE HOSPICE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	105
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	13
Total of all active and inactive participants	2015-01-01	118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	118
Number of participants with account balances	2015-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CAMBRIDGE HOSPICE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	118
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	120
Number of participants with account balances	2014-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on CAMBRIDGE HOSPICE 401(K) PLAN

Measure	Date	Value
2019 : CAMBRIDGE HOSPICE 401(K) PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$-420,335
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$48,338
Expenses. Total of all expenses incurred	2019-12-31	$40,111
Benefits paid (including direct rollovers)	2019-12-31	$36,206
Total plan assets at end of year	2019-12-31	$0
Total plan assets at beginning of year	2019-12-31	$412,108
Value of fidelity bond covering the plan	2019-12-31	$250,000
Total contributions received or receivable from participants	2019-12-31	$34,138
Contributions received from other sources (not participants or employers)	2019-12-31	$8,040
Other income received	2019-12-31	$6,160
Net income (gross income less expenses)	2019-12-31	$8,227
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$412,108
Assets. Value of participant loans	2019-12-31	$0
Total contributions received or receivable from employer(s)	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$3,905
2018 : CAMBRIDGE HOSPICE 401(K) PLAN 2018 401k financial data
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$8,147
Total income from all sources	2018-12-31	$165,649
Expenses. Total of all expenses incurred	2018-12-31	$245,512
Benefits paid (including direct rollovers)	2018-12-31	$237,601
Total plan assets at end of year	2018-12-31	$412,108
Total plan assets at beginning of year	2018-12-31	$500,118
Value of fidelity bond covering the plan	2018-12-31	$250,000
Total contributions received or receivable from participants	2018-12-31	$128,848
Contributions received from other sources (not participants or employers)	2018-12-31	$26,603
Other income received	2018-12-31	$-16,311
Net income (gross income less expenses)	2018-12-31	$-79,863
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$412,108
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$491,971
Assets. Value of participant loans	2018-12-31	$26,193
Total contributions received or receivable from employer(s)	2018-12-31	$26,509
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$7,911
2017 : CAMBRIDGE HOSPICE 401(K) PLAN 2017 401k financial data
Total plan liabilities at end of year	2017-12-31	$8,147
Total plan liabilities at beginning of year	2017-12-31	$4,892
Total income from all sources	2017-12-31	$228,519
Expenses. Total of all expenses incurred	2017-12-31	$493,591
Benefits paid (including direct rollovers)	2017-12-31	$489,340
Total plan assets at end of year	2017-12-31	$500,118
Total plan assets at beginning of year	2017-12-31	$761,935
Value of fidelity bond covering the plan	2017-12-31	$250,000
Total contributions received or receivable from participants	2017-12-31	$117,672
Contributions received from other sources (not participants or employers)	2017-12-31	$1,799
Other income received	2017-12-31	$81,964
Net income (gross income less expenses)	2017-12-31	$-265,072
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$491,971
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$757,043
Assets. Value of participant loans	2017-12-31	$15,953
Total contributions received or receivable from employer(s)	2017-12-31	$27,084
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$4,251
2016 : CAMBRIDGE HOSPICE 401(K) PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$4,892
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$205,675
Expenses. Total of all expenses incurred	2016-12-31	$144,228
Benefits paid (including direct rollovers)	2016-12-31	$140,564
Total plan assets at end of year	2016-12-31	$761,935
Total plan assets at beginning of year	2016-12-31	$695,596
Total contributions received or receivable from participants	2016-12-31	$88,696
Contributions received from other sources (not participants or employers)	2016-12-31	$30,390
Other income received	2016-12-31	$42,242
Net income (gross income less expenses)	2016-12-31	$61,447
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$757,043
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$695,596
Assets. Value of participant loans	2016-12-31	$31,530
Total contributions received or receivable from employer(s)	2016-12-31	$44,347
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$3,664
2015 : CAMBRIDGE HOSPICE 401(K) PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$101,474
Expenses. Total of all expenses incurred	2015-12-31	$6,138
Benefits paid (including direct rollovers)	2015-12-31	$2,757
Total plan assets at end of year	2015-12-31	$695,596
Total plan assets at beginning of year	2015-12-31	$600,260
Total contributions received or receivable from participants	2015-12-31	$107,953
Contributions received from other sources (not participants or employers)	2015-12-31	$5,687
Other income received	2015-12-31	$-12,166
Net income (gross income less expenses)	2015-12-31	$95,336
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$695,596
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$600,260
Assets. Value of participant loans	2015-12-31	$38,652
Total contributions received or receivable from employer(s)	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$3,381
2014 : CAMBRIDGE HOSPICE 401(K) PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total income from all sources	2014-12-31	$601,478
Expenses. Total of all expenses incurred	2014-12-31	$1,218
Total plan assets at end of year	2014-12-31	$600,260
Total plan assets at beginning of year	2014-12-31	$0
Total contributions received or receivable from participants	2014-12-31	$63,549
Contributions received from other sources (not participants or employers)	2014-12-31	$533,240
Other income received	2014-12-31	$4,689
Net income (gross income less expenses)	2014-12-31	$600,260
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$600,260
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$0
Assets. Value of participant loans	2014-12-31	$48,232
Total contributions received or receivable from employer(s)	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,218

Form 5500 Responses for CAMBRIDGE HOSPICE 401(K) PLAN

2019: CAMBRIDGE HOSPICE 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CAMBRIDGE HOSPICE 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CAMBRIDGE HOSPICE 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CAMBRIDGE HOSPICE 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CAMBRIDGE HOSPICE 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CAMBRIDGE HOSPICE 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114754

Policy instance

Insurance contract or identification number	114754
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $470
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	470
Additional information about fees paid to insurance broker	TPA FEES AND COMPENSATION
Insurance broker organization code?	5

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114754

Policy instance

Insurance contract or identification number	114754
Number of Individuals Covered	88
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $738
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	59
Additional information about fees paid to insurance broker	OTHER ALLOWANCES
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114754

Policy instance

Insurance contract or identification number	114754
Number of Individuals Covered	61
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,740
Total amount of fees paid to insurance company	USD $1,203
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,740
Amount paid for insurance broker fees	302
Additional information about fees paid to insurance broker	OTHER ALLOWANCES
Insurance broker organization code?	3
Insurance broker name	WAKE FINANCIAL GROUP, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114754

Policy instance

Insurance contract or identification number	114754
Number of Individuals Covered	34
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,051
Total amount of fees paid to insurance company	USD $303
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,051
Amount paid for insurance broker fees	253
Additional information about fees paid to insurance broker	COMMISSIONS AND OTHER ALLOWANCES
Insurance broker organization code?	3
Insurance broker name	WAKE FINANCIAL GROUP, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

114754

Policy instance

Insurance contract or identification number	114754
Number of Individuals Covered	29
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $837
Total amount of fees paid to insurance company	USD $135
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $837
Amount paid for insurance broker fees	35
Additional information about fees paid to insurance broker	COMMISSIONS AND OTHER ALLOWANCES
Insurance broker organization code?	3
Insurance broker name	WAKE FINANCIAL GROUP, INC.

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Company Name:	CAMBRIDGE HOSPICE
Employer identification number (EIN):	453481847
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities