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ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN 401k Plan overview

Plan NameANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN
Plan identification number 001

ANIMAL CRITICAL CARE AND SPECIALTY GROUP, 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.
  • 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

ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name:ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC.
Employer identification number (EIN):201696837
NAIC Classification:541940
NAIC Description:Veterinary Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01DENNIS BURKETT2019-05-20
0012017-01-01DENNIS BURKETT2018-07-31
0012016-01-01DENNIS BURKETT2017-07-31
0012015-01-01DENNIS BURKETT2016-06-29
0012014-01-01DENNIS BURKETT2015-07-31
0012013-01-01DENNIS BURKETT2014-08-01
0012012-01-01DENNIS BURKETT2013-10-04
0012011-01-01DENNIS BURKETT2012-10-15
0012010-01-01DENNIS BURKETT2011-07-29

Plan Statistics for ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN

401k plan membership statisitcs for ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN

Measure Date Value
2021: ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0188
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-010
Number of participants with account balances2021-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01142
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0188
Total of all active and inactive participants2020-01-0188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0188
Number of participants with account balances2020-01-0188
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01134
Total number of active participants reported on line 7a of the Form 55002019-01-0199
Number of retired or separated participants receiving benefits2019-01-013
Number of other retired or separated participants entitled to future benefits2019-01-0124
Total of all active and inactive participants2019-01-01126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01126
Number of participants with account balances2019-01-0194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010

Financial Data on ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN

Measure Date Value
2021 : ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-03-31$0
Total income from all sources (including contributions)2021-03-31$166,113
Total loss/gain on sale of assets2021-03-31$0
Total of all expenses incurred2021-03-31$4,872,054
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-03-31$4,870,382
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-03-31$0
Value of total assets at end of year2021-03-31$0
Value of total assets at beginning of year2021-03-31$4,705,941
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-03-31$1,672
Total interest from all sources2021-03-31$86
Total dividends received (eg from common stock, registered investment company shares)2021-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-03-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2021-03-31$0
Was this plan covered by a fidelity bond2021-03-31Yes
Value of fidelity bond cover2021-03-31$350,000
If this is an individual account plan, was there a blackout period2021-03-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-03-31$0
Were there any nonexempt tranactions with any party-in-interest2021-03-31No
Contributions received from participants2021-03-31$0
Participant contributions at end of year2021-03-31$0
Participant contributions at beginning of year2021-03-31$10,126
Participant contributions at end of year2021-03-31$0
Participant contributions at beginning of year2021-03-31$0
Administrative expenses (other) incurred2021-03-31$0
Total non interest bearing cash at end of year2021-03-31$0
Total non interest bearing cash at beginning of year2021-03-31$119
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Value of net income/loss2021-03-31$-4,705,941
Value of net assets at end of year (total assets less liabilities)2021-03-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-03-31$4,705,941
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-03-31No
Were any leases to which the plan was party in default or uncollectible2021-03-31No
Value of interest in pooled separate accounts at end of year2021-03-31$0
Value of interest in pooled separate accounts at beginning of year2021-03-31$4,695,696
Interest on participant loans2021-03-31$86
Net investment gain/loss from pooled separate accounts2021-03-31$166,027
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-03-31No
Was there a failure to transmit to the plan any participant contributions2021-03-31No
Has the plan failed to provide any benefit when due under the plan2021-03-31No
Contributions received in cash from employer2021-03-31$0
Employer contributions (assets) at end of year2021-03-31$0
Employer contributions (assets) at beginning of year2021-03-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-03-31$4,870,382
Contract administrator fees2021-03-31$1,672
Did the plan have assets held for investment2021-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-03-31Yes
Opinion of an independent qualified public accountant for this plan2021-03-31Disclaimer
Accountancy firm name2021-03-31BERKOWITZ & BERKOWITZ CPAS
Accountancy firm EIN2021-03-31232000627
2020 : ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,078,592
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$428,238
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$420,248
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$374,272
Value of total assets at end of year2020-12-31$4,705,941
Value of total assets at beginning of year2020-12-31$4,055,587
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$7,990
Total interest from all sources2020-12-31$544
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$350,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$230,049
Participant contributions at end of year2020-12-31$10,126
Participant contributions at beginning of year2020-12-31$14,893
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$9,579
Other income not declared elsewhere2020-12-31$2,436
Administrative expenses (other) incurred2020-12-31$225
Total non interest bearing cash at end of year2020-12-31$119
Total non interest bearing cash at beginning of year2020-12-31$119
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$650,354
Value of net assets at end of year (total assets less liabilities)2020-12-31$4,705,941
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$4,055,587
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in pooled separate accounts at end of year2020-12-31$4,695,696
Value of interest in pooled separate accounts at beginning of year2020-12-31$3,793,430
Interest on participant loans2020-12-31$544
Net investment gain/loss from pooled separate accounts2020-12-31$701,340
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$144,223
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$237,566
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$420,248
Contract administrator fees2020-12-31$7,765
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31BERKOWITZ & BERKOWITZ CPAS
Accountancy firm EIN2020-12-31232000627
2019 : ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,329,717
Total income from all sources (including contributions)2019-12-31$1,329,717
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$381,755
Total of all expenses incurred2019-12-31$381,755
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$374,693
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$374,693
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$663,304
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$663,304
Value of total assets at end of year2019-12-31$4,055,587
Value of total assets at end of year2019-12-31$4,055,587
Value of total assets at beginning of year2019-12-31$3,107,625
Value of total assets at beginning of year2019-12-31$3,107,625
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$7,062
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$7,062
Total interest from all sources2019-12-31$1,000
Total interest from all sources2019-12-31$1,000
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$350,000
Value of fidelity bond cover2019-12-31$350,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$387,925
Contributions received from participants2019-12-31$387,925
Participant contributions at end of year2019-12-31$14,893
Participant contributions at end of year2019-12-31$14,893
Participant contributions at beginning of year2019-12-31$27,256
Participant contributions at beginning of year2019-12-31$27,256
Participant contributions at end of year2019-12-31$9,579
Participant contributions at end of year2019-12-31$9,579
Participant contributions at beginning of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$37,813
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$37,813
Other income not declared elsewhere2019-12-31$1,651
Other income not declared elsewhere2019-12-31$1,651
Administrative expenses (other) incurred2019-12-31$150
Administrative expenses (other) incurred2019-12-31$150
Total non interest bearing cash at end of year2019-12-31$119
Total non interest bearing cash at end of year2019-12-31$119
Total non interest bearing cash at beginning of year2019-12-31$119
Total non interest bearing cash at beginning of year2019-12-31$119
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$947,962
Value of net income/loss2019-12-31$947,962
Value of net assets at end of year (total assets less liabilities)2019-12-31$4,055,587
Value of net assets at end of year (total assets less liabilities)2019-12-31$4,055,587
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,107,625
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,107,625
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$3,793,430
Value of interest in pooled separate accounts at end of year2019-12-31$3,793,430
Value of interest in pooled separate accounts at beginning of year2019-12-31$2,869,185
Value of interest in pooled separate accounts at beginning of year2019-12-31$2,869,185
Interest on participant loans2019-12-31$1,000
Interest on participant loans2019-12-31$1,000
Net investment gain/loss from pooled separate accounts2019-12-31$663,762
Net investment gain/loss from pooled separate accounts2019-12-31$663,762
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$237,566
Contributions received in cash from employer2019-12-31$237,566
Employer contributions (assets) at end of year2019-12-31$237,566
Employer contributions (assets) at end of year2019-12-31$237,566
Employer contributions (assets) at beginning of year2019-12-31$211,065
Employer contributions (assets) at beginning of year2019-12-31$211,065
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$374,693
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$374,693
Contract administrator fees2019-12-31$6,912
Contract administrator fees2019-12-31$6,912
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31BERKOWITZ & BERKOWITZ CPAS
Accountancy firm name2019-12-31BERKOWITZ & BERKOWITZ CPAS
Accountancy firm EIN2019-12-31232000627
Accountancy firm EIN2019-12-31232000627

Form 5500 Responses for ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) PLAN

2021: ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) 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 filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)Yes
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: ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) 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 – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: ANIMAL CRITICAL CARE AND SPECIALTY GROUP, INC. 401(K) 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 – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan 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 number66356
Policy instance 1
Insurance contract or identification number66356
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-03-09
Total amount of commissions paid to insurance brokerUSD $5,772
Total amount of fees paid to insurance companyUSD $0
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 $5,772
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66356
Policy instance 1
Insurance contract or identification number66356
Number of Individuals Covered93
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $19,663
Total amount of fees paid to insurance companyUSD $225
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 $19,663
Insurance broker organization code?3
Amount paid for insurance broker fees225
Additional information about fees paid to insurance brokerTPA COMPENSATION
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66356
Policy instance 1
Insurance contract or identification number66356
Number of Individuals Covered97
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $16,939
Total amount of fees paid to insurance companyUSD $1,910
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 $16,939
Insurance broker organization code?3
Amount paid for insurance broker fees1910
Additional information about fees paid to insurance brokerTPA COMPENSATION

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