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CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 401k Plan overview

Plan NameCLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN
Plan identification number 001

CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP 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.
  • 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.
  • 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.
  • ESOP other than a leveraged ESOP - A completed Schedule E must be attached to a Form 5500 filed for an Employee Stock Ownership Plan (ESOP).
  • The employer maintaining this ESOP is an S Corporation
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).
  • Plan requiring that all or part of employer contributions be invested and held, at least for a limited period, in employer securities.

401k Sponsoring company profile

CLEAN AIR QUALITY SERVICE, INC. has sponsored the creation of one or more 401k plans.

Company Name:CLEAN AIR QUALITY SERVICE, INC.
Employer identification number (EIN):133704147
NAIC Classification:238220
NAIC Description:Plumbing, Heating, and Air-Conditioning Contractors

Additional information about CLEAN AIR QUALITY SERVICE, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1993-02-12
Company Identification Number: 1702336
Legal Registered Office Address: 161 BRADY AVE
Westchester
HAWTHORNE
United States of America (USA)
10532

More information about CLEAN AIR QUALITY SERVICE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01RUSSELL SEACOR2023-10-11
0012021-01-01RUSSELL SEACOR2022-10-11
0012020-01-01RUSSELL SEACOR2021-10-14
0012019-01-01RUSSELL SEACOR2020-10-14
0012018-01-01RUSSELL SEACOR2019-10-11
0012017-01-01
0012016-01-01
0012016-01-01RUSSELL SEACOR2018-10-10
0012015-01-01
0012014-01-01RUSSELL SEACOR2015-05-15
0012013-01-01RUSSELL SEACOR2014-06-20
0012012-01-01RUSSELL SEACOR2013-06-21
0012011-01-01RUSSELL SEACOR2012-05-29
0012010-01-01RUSSELL SEACOR2011-05-31

Plan Statistics for CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN

401k plan membership statisitcs for CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN

Measure Date Value
2022: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0133
Total number of active participants reported on line 7a of the Form 55002022-01-0124
Number of retired or separated participants receiving benefits2022-01-014
Number of other retired or separated participants entitled to future benefits2022-01-016
Total of all active and inactive participants2022-01-0134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0134
Number of participants with account balances2022-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-011
2021: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0131
Total number of active participants reported on line 7a of the Form 55002021-01-0125
Number of retired or separated participants receiving benefits2021-01-012
Number of other retired or separated participants entitled to future benefits2021-01-014
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 balances2021-01-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0124
Total number of active participants reported on line 7a of the Form 55002020-01-0118
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-016
Total of all active and inactive participants2020-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0124
Number of participants with account balances2020-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-011
2019: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0121
Total number of active participants reported on line 7a of the Form 55002019-01-0118
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-015
Total of all active and inactive participants2019-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0123
Number of participants with account balances2019-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-011
2018: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0117
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 benefits2018-01-010
Total of all active and inactive participants2018-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0117
Number of participants with account balances2018-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0119
Total number of active participants reported on line 7a of the Form 55002017-01-0114
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 participants2017-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0116
Number of participants with account balances2017-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0119
Total number of active participants reported on line 7a of the Form 55002016-01-0119
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0119
Number of participants with account balances2016-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-012
2015: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0117
Total number of active participants reported on line 7a of the Form 55002015-01-0115
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 participants2015-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0117
Number of participants with account balances2015-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011

Financial Data on CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN

Measure Date Value
2022 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2022 401k financial data
Total income from all sources2022-12-31$614,733
Expenses. Total of all expenses incurred2022-12-31$7,334,757
Benefits paid (including direct rollovers)2022-12-31$7,334,347
Total plan assets at end of year2022-12-31$21,231,132
Total plan assets at beginning of year2022-12-31$27,951,156
Value of fidelity bond covering the plan2022-12-31$575,000
Total contributions received or receivable from participants2022-12-31$55,368
Expenses. Other expenses not covered elsewhere2022-12-31$410
Other income received2022-12-31$64,365
Net income (gross income less expenses)2022-12-31$-6,720,024
Net plan assets at end of year (total assets less liabilities)2022-12-31$21,231,132
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$27,951,156
Assets. Value of participant loans2022-12-31$74,188
Assets. Value of employer securities2022-12-31$18,999,005
Total contributions received or receivable from employer(s)2022-12-31$495,000
2021 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2021 401k financial data
Total income from all sources2021-12-31$5,630,241
Expenses. Total of all expenses incurred2021-12-31$51,628
Benefits paid (including direct rollovers)2021-12-31$51,474
Total plan assets at end of year2021-12-31$27,951,156
Total plan assets at beginning of year2021-12-31$22,372,543
Value of fidelity bond covering the plan2021-12-31$575,000
Total contributions received or receivable from participants2021-12-31$35,029
Expenses. Other expenses not covered elsewhere2021-12-31$154
Other income received2021-12-31$5,595,212
Net income (gross income less expenses)2021-12-31$5,578,613
Net plan assets at end of year (total assets less liabilities)2021-12-31$27,951,156
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$22,372,543
Assets. Value of participant loans2021-12-31$8,931
Assets. Value of employer securities2021-12-31$25,482,915
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2020 401k financial data
Total income from all sources2020-12-31$8,503,113
Expenses. Total of all expenses incurred2020-12-31$120
Total plan assets at end of year2020-12-31$22,372,543
Total plan assets at beginning of year2020-12-31$13,869,550
Value of fidelity bond covering the plan2020-12-31$575,000
Total contributions received or receivable from participants2020-12-31$29,490
Other income received2020-12-31$8,338,623
Net income (gross income less expenses)2020-12-31$8,502,993
Net plan assets at end of year (total assets less liabilities)2020-12-31$22,372,543
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$13,869,550
Assets. Value of participant loans2020-12-31$16,001
Assets. Value of employer securities2020-12-31$20,160,725
Total contributions received or receivable from employer(s)2020-12-31$135,000
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$120
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$0
Total plan liabilities at beginning of year2019-12-31$200,367
Total income from all sources2019-12-31$4,282,688
Expenses. Total of all expenses incurred2019-12-31$320
Benefits paid (including direct rollovers)2019-12-31$0
Total plan assets at end of year2019-12-31$13,869,550
Total plan assets at beginning of year2019-12-31$9,787,549
Value of fidelity bond covering the plan2019-12-31$575,000
Total contributions received or receivable from participants2019-12-31$16,698
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$4,135,990
Noncash contributions received2019-12-31$0
Net income (gross income less expenses)2019-12-31$4,282,368
Net plan assets at end of year (total assets less liabilities)2019-12-31$13,869,550
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$9,587,182
Assets. Value of participant loans2019-12-31$20,964
Assets. Value of employer securities2019-12-31$12,126,015
Total contributions received or receivable from employer(s)2019-12-31$130,000
Value of certain deemed distributions of participant loans2019-12-31$0
Value of corrective distributions2019-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$320
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$200,367
Total plan liabilities at beginning of year2018-12-31$0
Total income from all sources2018-12-31$93,624
Expenses. Total of all expenses incurred2018-12-31$264,278
Benefits paid (including direct rollovers)2018-12-31$264,209
Total plan assets at end of year2018-12-31$9,787,549
Total plan assets at beginning of year2018-12-31$9,757,836
Value of fidelity bond covering the plan2018-12-31$575,000
Total contributions received or receivable from participants2018-12-31$17,237
Other income received2018-12-31$-303,693
Net income (gross income less expenses)2018-12-31$-170,654
Net plan assets at end of year (total assets less liabilities)2018-12-31$9,587,182
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$9,757,836
Assets. Value of participant loans2018-12-31$13,373
Assets. Value of employer securities2018-12-31$8,238,540
Total contributions received or receivable from employer(s)2018-12-31$380,080
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$69
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$39,672
Total income from all sources2017-12-31$4,411,201
Expenses. Total of all expenses incurred2017-12-31$2,673
Benefits paid (including direct rollovers)2017-12-31$31
Total plan assets at end of year2017-12-31$9,757,836
Total plan assets at beginning of year2017-12-31$5,388,980
Value of fidelity bond covering the plan2017-12-31$575,000
Total contributions received or receivable from participants2017-12-31$14,105
Other income received2017-12-31$4,267,096
Net income (gross income less expenses)2017-12-31$4,408,528
Net plan assets at end of year (total assets less liabilities)2017-12-31$9,757,836
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$5,349,308
Assets. Value of participant loans2017-12-31$17,101
Assets. Value of employer securities2017-12-31$8,436,505
Total contributions received or receivable from employer(s)2017-12-31$130,000
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$2,642
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$39,672
Total income from all sources2016-12-31$3,868,318
Expenses. Total of all expenses incurred2016-12-31$46,851
Benefits paid (including direct rollovers)2016-12-31$44,749
Total plan assets at end of year2016-12-31$5,428,652
Total plan assets at beginning of year2016-12-31$1,567,513
Value of fidelity bond covering the plan2016-12-31$575,000
Total contributions received or receivable from participants2016-12-31$11,750
Other income received2016-12-31$3,730,253
Net income (gross income less expenses)2016-12-31$3,821,467
Net plan assets at end of year (total assets less liabilities)2016-12-31$5,388,980
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,567,513
Assets. Value of participant loans2016-12-31$20,276
Assets. Value of employer securities2016-12-31$4,328,115
Total contributions received or receivable from employer(s)2016-12-31$126,315
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$2,102
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2015 401k financial data
Total income from all sources2015-12-31$492,837
Expenses. Total of all expenses incurred2015-12-31$3,205
Total plan assets at end of year2015-12-31$1,693,820
Total plan assets at beginning of year2015-12-31$1,204,188
Value of fidelity bond covering the plan2015-12-31$130,000
Total contributions received or receivable from participants2015-12-31$15,079
Other income received2015-12-31$185,322
Net income (gross income less expenses)2015-12-31$489,632
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,693,820
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,204,188
Assets. Value of participant loans2015-12-31$14,526
Assets. Value of employer securities2015-12-31$639,965
Total contributions received or receivable from employer(s)2015-12-31$292,436
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$3,205
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0

Form 5500 Responses for CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN

2022: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 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 – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 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 – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 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 – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP 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 – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP 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 – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: CLEAN AIR QUALITY SERVICE, INC. 401(K) AND EMPLOYEE STOCK OWNERSHIP 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 – TrustYes
2015-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )
Policy contract number284777
Policy instance 1
Insurance contract or identification number284777
Number of Individuals Covered25
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $10,042
Total amount of fees paid to insurance companyUSD $1,029
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?Yes
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 $10,042
Insurance broker organization code?3
Amount paid for insurance broker fees1029
Additional information about fees paid to insurance brokerTPA COMPENSATION
JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )
Policy contract number284777
Policy instance 1
Insurance contract or identification number284777
Number of Individuals Covered25
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $10,753
Total amount of fees paid to insurance companyUSD $1,083
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 $10,753
Insurance broker organization code?3
Amount paid for insurance broker fees1083
Additional information about fees paid to insurance brokerTPA COMPENSATION

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