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DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 401k Plan overview

Plan NameDR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN
Plan identification number 001

DR. DAVID F. OUELLET, D.D.S., INC. 401(K) 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.
  • 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

DR. DAVID F. OUELETT, D.D.S., INC. has sponsored the creation of one or more 401k plans.

Company Name:DR. DAVID F. OUELETT, D.D.S., INC.
Employer identification number (EIN):770516642
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01DAVID OUELLET, D.D.S.2021-10-15
0012019-01-01DAVID OUELLET, D.D.S.2020-10-15
0012018-01-01DAVID OUELLET, D.D.S.2019-10-14
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01DAVID OUELLET, D.D.S.

Plan Statistics for DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN

401k plan membership statisitcs for DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN

Measure Date Value
2022: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0117
Total number of active participants reported on line 7a of the Form 55002022-01-012
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-012
Number of participants with account balances2022-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0120
Total number of active participants reported on line 7a of the Form 55002021-01-012
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0115
Total of all active and inactive participants2021-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0117
Number of participants with account balances2021-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0116
Total number of active participants reported on line 7a of the Form 55002020-01-0115
Number of other retired or separated participants entitled to future benefits2020-01-014
Total of all active and inactive participants2020-01-0119
Total participants2020-01-0119
Number of participants with account balances2020-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0114
Total number of active participants reported on line 7a of the Form 55002019-01-0110
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-014
Total of all active and inactive participants2019-01-0114
Total participants2019-01-0114
Number of participants with account balances2019-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0114
Total number of active participants reported on line 7a of the Form 55002018-01-0112
Number of other retired or separated participants entitled to future benefits2018-01-011
Total of all active and inactive participants2018-01-0113
Total participants2018-01-0113
Number of participants with account balances2018-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0114
Total number of active participants reported on line 7a of the Form 55002017-01-0111
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-012
Total of all active and inactive participants2017-01-0113
Total participants2017-01-0113
Number of participants with account balances2017-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0110
Total number of active participants reported on line 7a of the Form 55002016-01-0113
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-0114
Total participants2016-01-0114
Number of participants with account balances2016-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0112
Total number of active participants reported on line 7a of the Form 55002015-01-0110
Total of all active and inactive participants2015-01-0110
Total participants2015-01-0110
Number of participants with account balances2015-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0114
Total number of active participants reported on line 7a of the Form 55002014-01-018
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-014
Total of all active and inactive participants2014-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0112
Number of participants with account balances2014-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-010
Total number of active participants reported on line 7a of the Form 55002013-01-0111
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-013
Total of all active and inactive participants2013-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0114
Number of participants with account balances2013-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010

Financial Data on DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN

Measure Date Value
2022 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2022 401k financial data
Transfers to/from the plan2022-12-31$0
Total income from all sources2022-12-31$553,234
Expenses. Total of all expenses incurred2022-12-31$287,964
Benefits paid (including direct rollovers)2022-12-31$152,612
Total plan assets at end of year2022-12-31$1,971,519
Total plan assets at beginning of year2022-12-31$1,706,249
Value of fidelity bond covering the plan2022-12-31$500,000
Total contributions received or receivable from participants2022-12-31$15,022
Expenses. Other expenses not covered elsewhere2022-12-31$132,651
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$529,852
Net income (gross income less expenses)2022-12-31$265,270
Net plan assets at end of year (total assets less liabilities)2022-12-31$1,971,519
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$1,706,249
Assets. Value of real-estate (other than employer real property)2022-12-31$1,961,000
Total contributions received or receivable from employer(s)2022-12-31$8,360
Value of certain deemed distributions of participant loans2022-12-31$0
Value of corrective distributions2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$2,701
2021 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2021 401k financial data
Total income from all sources2021-12-31$-474,642
Expenses. Total of all expenses incurred2021-12-31$8,000
Benefits paid (including direct rollovers)2021-12-31$4,913
Total plan assets at end of year2021-12-31$1,095,034
Total plan assets at beginning of year2021-12-31$1,577,676
Value of fidelity bond covering the plan2021-12-31$250,000
Total contributions received or receivable from participants2021-12-31$24,076
Expenses. Other expenses not covered elsewhere2021-12-31$3,087
Other income received2021-12-31$-535,326
Net income (gross income less expenses)2021-12-31$-482,642
Net plan assets at end of year (total assets less liabilities)2021-12-31$1,095,034
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$1,577,676
Assets. Value of real-estate (other than employer real property)2021-12-31$845,000
Total contributions received or receivable from employer(s)2021-12-31$36,608
2020 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2020 401k financial data
Total income from all sources2020-12-31$447,298
Expenses. Total of all expenses incurred2020-12-31$2,667
Total plan assets at end of year2020-12-31$1,577,676
Total plan assets at beginning of year2020-12-31$1,133,045
Value of fidelity bond covering the plan2020-12-31$250,000
Total contributions received or receivable from participants2020-12-31$67,379
Other income received2020-12-31$361,750
Net income (gross income less expenses)2020-12-31$444,631
Net plan assets at end of year (total assets less liabilities)2020-12-31$1,577,676
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$1,133,045
Assets. Value of real-estate (other than employer real property)2020-12-31$1,379,000
Total contributions received or receivable from employer(s)2020-12-31$18,169
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$2,667
2019 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2019 401k financial data
Total income from all sources2019-12-31$343,372
Expenses. Total of all expenses incurred2019-12-31$26,024
Total plan assets at end of year2019-12-31$1,133,045
Total plan assets at beginning of year2019-12-31$815,697
Value of fidelity bond covering the plan2019-12-31$250,000
Total contributions received or receivable from participants2019-12-31$64,286
Expenses. Other expenses not covered elsewhere2019-12-31$25,994
Contributions received from other sources (not participants or employers)2019-12-31$216,637
Other income received2019-12-31$41,712
Net income (gross income less expenses)2019-12-31$317,348
Net plan assets at end of year (total assets less liabilities)2019-12-31$1,133,045
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$815,697
Assets. Value of real-estate (other than employer real property)2019-12-31$1,011,443
Total contributions received or receivable from employer(s)2019-12-31$20,737
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$30
2018 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$105,128
Expenses. Total of all expenses incurred2018-12-31$33,512
Benefits paid (including direct rollovers)2018-12-31$15,499
Total plan assets at end of year2018-12-31$804,296
Total plan assets at beginning of year2018-12-31$732,680
Value of fidelity bond covering the plan2018-12-31$250,000
Total contributions received or receivable from participants2018-12-31$59,447
Expenses. Other expenses not covered elsewhere2018-12-31$15,761
Other income received2018-12-31$36,858
Net income (gross income less expenses)2018-12-31$71,616
Net plan assets at end of year (total assets less liabilities)2018-12-31$804,296
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$732,680
Assets. Value of real-estate (other than employer real property)2018-12-31$615,000
Total contributions received or receivable from employer(s)2018-12-31$8,823
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$2,252
2017 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$134,648
Expenses. Total of all expenses incurred2017-12-31$63,035
Benefits paid (including direct rollovers)2017-12-31$6,485
Total plan assets at end of year2017-12-31$732,680
Total plan assets at beginning of year2017-12-31$661,067
Value of fidelity bond covering the plan2017-12-31$250,000
Total contributions received or receivable from participants2017-12-31$50,393
Expenses. Other expenses not covered elsewhere2017-12-31$54,075
Other income received2017-12-31$64,409
Net income (gross income less expenses)2017-12-31$71,613
Net plan assets at end of year (total assets less liabilities)2017-12-31$732,680
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$661,067
Assets. Value of real-estate (other than employer real property)2017-12-31$615,000
Total contributions received or receivable from employer(s)2017-12-31$19,846
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$2,475
2016 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2016 401k financial data
Total income from all sources2016-12-31$213,207
Expenses. Total of all expenses incurred2016-12-31$9,389
Total plan assets at end of year2016-12-31$661,067
Total plan assets at beginning of year2016-12-31$457,249
Value of fidelity bond covering the plan2016-12-31$250,000
Total contributions received or receivable from participants2016-12-31$59,637
Expenses. Other expenses not covered elsewhere2016-12-31$7,219
Other income received2016-12-31$132,100
Net income (gross income less expenses)2016-12-31$203,818
Net plan assets at end of year (total assets less liabilities)2016-12-31$661,067
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$457,249
Assets. Value of real-estate (other than employer real property)2016-12-31$580,720
Total contributions received or receivable from employer(s)2016-12-31$21,470
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$2,170
2015 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2015 401k financial data
Total income from all sources2015-12-31$72,028
Expenses. Total of all expenses incurred2015-12-31$16,577
Benefits paid (including direct rollovers)2015-12-31$5,793
Total plan assets at end of year2015-12-31$457,249
Total plan assets at beginning of year2015-12-31$401,798
Value of fidelity bond covering the plan2015-12-31$250,000
Total contributions received or receivable from participants2015-12-31$58,783
Expenses. Other expenses not covered elsewhere2015-12-31$8,667
Other income received2015-12-31$-8,604
Net income (gross income less expenses)2015-12-31$55,451
Net plan assets at end of year (total assets less liabilities)2015-12-31$457,249
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$401,798
Assets. Value of real-estate (other than employer real property)2015-12-31$375,000
Total contributions received or receivable from employer(s)2015-12-31$21,849
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$2,117
2014 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2014 401k financial data
Total income from all sources2014-12-31$185,245
Expenses. Total of all expenses incurred2014-12-31$11,604
Benefits paid (including direct rollovers)2014-12-31$932
Total plan assets at end of year2014-12-31$401,798
Total plan assets at beginning of year2014-12-31$228,157
Value of fidelity bond covering the plan2014-12-31$200,000
Total contributions received or receivable from participants2014-12-31$40,029
Expenses. Other expenses not covered elsewhere2014-12-31$9,008
Other income received2014-12-31$123,600
Net income (gross income less expenses)2014-12-31$173,641
Net plan assets at end of year (total assets less liabilities)2014-12-31$401,798
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$228,157
Assets. Value of real-estate (other than employer real property)2014-12-31$243,000
Total contributions received or receivable from employer(s)2014-12-31$21,616
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$1,664
2013 : DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$241,503
Expenses. Total of all expenses incurred2013-12-31$13,346
Total plan assets at end of year2013-12-31$228,157
Total plan assets at beginning of year2013-12-31$0
Value of fidelity bond covering the plan2013-12-31$200,000
Total contributions received or receivable from participants2013-12-31$29,465
Expenses. Other expenses not covered elsewhere2013-12-31$13,031
Contributions received from other sources (not participants or employers)2013-12-31$185,761
Other income received2013-12-31$6,965
Net income (gross income less expenses)2013-12-31$228,157
Net plan assets at end of year (total assets less liabilities)2013-12-31$228,157
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$0
Assets. Value of real-estate (other than employer real property)2013-12-31$138,500
Total contributions received or receivable from employer(s)2013-12-31$19,312
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$315

Form 5500 Responses for DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN

2022: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: DR. DAVID F. OUELLET, D.D.S., INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $226
Total amount of fees paid to insurance companyUSD $1,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1275
Additional information about fees paid to insurance brokerTPA FEE
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $226
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,164
Total amount of fees paid to insurance companyUSD $228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $608
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
Amount paid for insurance broker fees150
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Number of Individuals Covered11
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $917
Total amount of fees paid to insurance companyUSD $61
Commission paid to Insurance BrokerUSD $917
Insurance broker organization code?3
Amount paid for insurance broker fees61
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Number of Individuals Covered10
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $766
Commission paid to Insurance BrokerUSD $716
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Number of Individuals Covered7
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $597
Total amount of fees paid to insurance companyUSD $40
Commission paid to Insurance BrokerUSD $597
Insurance broker organization code?3
Amount paid for insurance broker fees40
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Number of Individuals Covered7
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees590
Insurance broker organization code?3
Insurance broker nameVOYA FINANCIAL ADVISORS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $323
Amount paid for insurance broker fees323
Insurance broker organization code?3
Insurance broker nameVOYA FINANCIAL ADVISORS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Number of Individuals Covered9
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $194
Amount paid for insurance broker fees194
Insurance broker organization code?3
Insurance broker nameVOYA FINANCIAL ADVISORS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110352
Policy instance 1
Insurance contract or identification number110352
Number of Individuals Covered9
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $41
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees41
Additional information about fees paid to insurance brokerBROKER FEES
Insurance broker organization code?3
Insurance broker nameING FINANCIAL PARTNERS

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