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THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan NameTHOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST
Plan identification number 001

THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 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.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

THOMAS J. ANDREWS, M.D., INC. has sponsored the creation of one or more 401k plans.

Company Name:THOMAS J. ANDREWS, M.D., INC.
Employer identification number (EIN):680342989
NAIC Classification:621112
NAIC Description:Offices of Physicians, Mental Health Specialists

Additional information about THOMAS J. ANDREWS, M.D., INC.

Jurisdiction of Incorporation: California Department of State
Incorporation Date: 1994-11-01
Company Identification Number: C1915909
Legal Registered Office Address: 2891 Churn Creek Rd

Redding
United States of America (USA)
96002

More information about THOMAS J. ANDREWS, M.D., INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01THOMAS J. ANDREWS, M.D.2023-09-07 THOMAS J. ANDREWS, M.D.2023-09-07
0012021-01-01THOMAS J. ANDREWS, M.D.2022-10-07 THOMAS J. ANDREWS, M.D.2022-10-07
0012020-01-01THOMAS J. ANDREWS, M.D.2021-07-21 THOMAS J. ANDREWS, M.D.2021-07-21
0012019-01-01THOMAS J. ANDREWS, M.D.2020-07-05 THOMAS J. ANDREWS, M.D.2020-07-05
0012018-01-01THOMAS J. ANDREWS, M.D.2019-09-12 THOMAS J. ANDREWS, M.D.2019-09-12
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01
0012012-01-01THOMAS J. ANDREWS, M.D.2014-01-22 THOMAS J. ANDREWS, M.D.2014-01-22
0012011-01-01THOMAS J. ANDREWS, M.D. THOMAS J. ANDREWS, M.D.2012-10-15
0012009-01-01THOMAS J ANDREWS MD THOMAS J ANDREWS MD2010-09-27

Plan Statistics for THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST

Measure Date Value
2022: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-0133
Total number of active participants reported on line 7a of the Form 55002022-01-0123
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-019
Total of all active and inactive participants2022-01-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0132
Number of participants with account balances2022-01-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-0132
Total number of active participants reported on line 7a of the Form 55002021-01-0122
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-019
Total of all active and inactive participants2021-01-0131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0131
Number of participants with account balances2021-01-0131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-0128
Total number of active participants reported on line 7a of the Form 55002020-01-0120
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-017
Total of all active and inactive participants2020-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0127
Number of participants with account balances2020-01-0127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-0124
Total number of active participants reported on line 7a of the Form 55002019-01-0120
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-017
Total of all active and inactive participants2019-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0127
Number of participants with account balances2019-01-0127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-0123
Total number of active participants reported on line 7a of the Form 55002018-01-0117
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-015
Total of all active and inactive participants2018-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0122
Number of participants with account balances2018-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-011
2017: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-0127
Total number of active participants reported on line 7a of the Form 55002017-01-0118
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-014
Total of all active and inactive participants2017-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0122
Number of participants with account balances2017-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2011: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0118
Total number of active participants reported on line 7a of the Form 55002011-01-0118
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0118
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 balances2011-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0114
Total number of active participants reported on line 7a of the Form 55002009-01-0117
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0117
Number of participants with account balances2009-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST

Measure Date Value
2022 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2022 401k financial data
Total plan liabilities at end of year2022-12-31$0
Total plan liabilities at beginning of year2022-12-31$0
Total income from all sources2022-12-31$-175,019
Expenses. Total of all expenses incurred2022-12-31$134,104
Benefits paid (including direct rollovers)2022-12-31$104,259
Total plan assets at end of year2022-12-31$2,504,240
Total plan assets at beginning of year2022-12-31$2,813,363
Value of fidelity bond covering the plan2022-12-31$500,000
Assets. Value of tangible personal property2022-12-31$277,831
Total contributions received or receivable from participants2022-12-31$126,856
Expenses. Other expenses not covered elsewhere2022-12-31$0
Contributions received from other sources (not participants or employers)2022-12-31$100
Other income received2022-12-31$-334,172
Net income (gross income less expenses)2022-12-31$-309,123
Net plan assets at end of year (total assets less liabilities)2022-12-31$2,504,240
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$2,813,363
Assets. Value of participant loans2022-12-31$47,393
Total contributions received or receivable from employer(s)2022-12-31$32,197
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$29,845
2021 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2021 401k financial data
Total income from all sources2021-12-31$534,509
Expenses. Total of all expenses incurred2021-12-31$71,043
Benefits paid (including direct rollovers)2021-12-31$39,355
Total plan assets at end of year2021-12-31$2,813,363
Total plan assets at beginning of year2021-12-31$2,349,897
Value of fidelity bond covering the plan2021-12-31$500,000
Assets. Value of tangible personal property2021-12-31$300,770
Total contributions received or receivable from participants2021-12-31$128,959
Expenses. Other expenses not covered elsewhere2021-12-31$0
Contributions received from other sources (not participants or employers)2021-12-31$0
Other income received2021-12-31$345,118
Net income (gross income less expenses)2021-12-31$463,466
Net plan assets at end of year (total assets less liabilities)2021-12-31$2,813,363
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$2,349,897
Assets. Value of participant loans2021-12-31$14,568
Total contributions received or receivable from employer(s)2021-12-31$60,432
Value of certain deemed distributions of participant loans2021-12-31$31,688
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$0
2020 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2020 401k financial data
Total income from all sources2020-12-31$528,014
Expenses. Total of all expenses incurred2020-12-31$136,223
Benefits paid (including direct rollovers)2020-12-31$112,058
Total plan assets at end of year2020-12-31$2,349,897
Total plan assets at beginning of year2020-12-31$1,958,106
Value of fidelity bond covering the plan2020-12-31$500,000
Assets. Value of tangible personal property2020-12-31$252,123
Total contributions received or receivable from participants2020-12-31$118,507
Expenses. Other expenses not covered elsewhere2020-12-31$0
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$358,307
Net income (gross income less expenses)2020-12-31$391,791
Net plan assets at end of year (total assets less liabilities)2020-12-31$2,349,897
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$1,958,106
Assets. Value of participant loans2020-12-31$12,793
Total contributions received or receivable from employer(s)2020-12-31$51,200
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$24,165
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2019 401k financial data
Total income from all sources2019-12-31$492,961
Expenses. Total of all expenses incurred2019-12-31$25,114
Benefits paid (including direct rollovers)2019-12-31$7,251
Total plan assets at end of year2019-12-31$1,958,106
Total plan assets at beginning of year2019-12-31$1,490,259
Value of fidelity bond covering the plan2019-12-31$500,000
Assets. Value of tangible personal property2019-12-31$205,657
Total contributions received or receivable from participants2019-12-31$109,220
Expenses. Other expenses not covered elsewhere2019-12-31$0
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$338,832
Net income (gross income less expenses)2019-12-31$467,847
Net plan assets at end of year (total assets less liabilities)2019-12-31$1,958,106
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$1,490,259
Assets. Value of participant loans2019-12-31$34,451
Total contributions received or receivable from employer(s)2019-12-31$44,909
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$17,863
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2018 401k financial data
Total income from all sources2018-12-31$61,684
Expenses. Total of all expenses incurred2018-12-31$279,731
Benefits paid (including direct rollovers)2018-12-31$263,249
Total plan assets at end of year2018-12-31$1,490,259
Total plan assets at beginning of year2018-12-31$1,708,306
Value of fidelity bond covering the plan2018-12-31$500,000
Assets. Value of tangible personal property2018-12-31$175,229
Total contributions received or receivable from participants2018-12-31$124,379
Expenses. Other expenses not covered elsewhere2018-12-31$0
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$-105,652
Net income (gross income less expenses)2018-12-31$-218,047
Net plan assets at end of year (total assets less liabilities)2018-12-31$1,490,259
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$1,708,306
Assets. Value of participant loans2018-12-31$49,354
Total contributions received or receivable from employer(s)2018-12-31$42,957
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$16,482
2017 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2017 401k financial data
Total income from all sources2017-12-31$364,878
Expenses. Total of all expenses incurred2017-12-31$65,093
Benefits paid (including direct rollovers)2017-12-31$64,373
Total plan assets at end of year2017-12-31$1,708,306
Total plan assets at beginning of year2017-12-31$1,408,521
Value of fidelity bond covering the plan2017-12-31$400,000
Assets. Value of tangible personal property2017-12-31$200,159
Total contributions received or receivable from participants2017-12-31$134,641
Expenses. Other expenses not covered elsewhere2017-12-31$0
Contributions received from other sources (not participants or employers)2017-12-31$0
Other income received2017-12-31$185,157
Net income (gross income less expenses)2017-12-31$299,785
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,708,306
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,408,521
Total contributions received or receivable from employer(s)2017-12-31$45,080
Value of certain deemed distributions of participant loans2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$720
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2011 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$110,401
Expenses. Total of all expenses incurred2011-12-31$11,497
Benefits paid (including direct rollovers)2011-12-31$11,497
Total plan assets at end of year2011-12-31$835,263
Total plan assets at beginning of year2011-12-31$736,359
Value of fidelity bond covering the plan2011-12-31$70,000
Total contributions received or receivable from participants2011-12-31$76,744
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$9,122
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$98,904
Net plan assets at end of year (total assets less liabilities)2011-12-31$835,263
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$736,359
Assets. Value of participant loans2011-12-31$22,205
Total contributions received or receivable from employer(s)2011-12-31$24,535
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$0
2010 : THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$64,492
Expenses. Total of all expenses incurred2010-12-31$3,782
Benefits paid (including direct rollovers)2010-12-31$3,782
Total plan assets at end of year2010-12-31$736,359
Total plan assets at beginning of year2010-12-31$675,649
Value of fidelity bond covering the plan2010-12-31$25,000
Total contributions received or receivable from participants2010-12-31$51,878
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$-12,350
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$60,710
Net plan assets at end of year (total assets less liabilities)2010-12-31$736,359
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$675,649
Assets. Value of participant loans2010-12-31$34,039
Total contributions received or receivable from employer(s)2010-12-31$24,964
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$0

Form 5500 Responses for THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST

2022: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 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: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 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: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final 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
2011: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: THOMAS J. ANDREWS, M.D., INC. PROFIT SHARING PLAN & TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – 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 number128143
Policy instance 1
Insurance contract or identification number128143
Number of Individuals Covered29
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,101
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1101
Additional information about fees paid to insurance brokerTPA 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 number128143
Policy instance 1
Insurance contract or identification number128143
Number of Individuals Covered26
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,121
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1121
Additional information about fees paid to insurance brokerTPA 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 number128143
Policy instance 1
Insurance contract or identification number128143
Number of Individuals Covered22
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,916
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1916
Additional information about fees paid to insurance brokerTPA COMPENSATION AND 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 number128143
Policy instance 1
Insurance contract or identification number128143
Number of Individuals Covered22
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,267
Total amount of fees paid to insurance companyUSD $1,217
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $6,267
Amount paid for insurance broker fees127
Additional information about fees paid to insurance brokerOTHER ALLOWANCES
Insurance broker organization code?7
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number128143
Policy instance 1
Insurance contract or identification number128143
Number of Individuals Covered20
Insurance policy start date2017-02-17
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $12,790
Total amount of fees paid to insurance companyUSD $4,493
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $12,790
Amount paid for insurance broker fees249
Additional information about fees paid to insurance brokerOTHER ALLOWANCES
Insurance broker organization code?7
Insurance broker namePROFESSIONAL PENSION SERVICES, INC.

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