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WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 401k Plan overview

Plan NameWORKHORSE TECHNOLOGIES, INC. 401(K) PLAN
Plan identification number 001

WORKHORSE TECHNOLOGIES, 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.
  • 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

WORKHORSE TECHNOLOGIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:WORKHORSE TECHNOLOGIES, INC.
Employer identification number (EIN):208529895
NAIC Classification:336210

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01KERRY RORAFF2023-10-16
0012021-01-01GREG ACKERSON2022-10-17
0012020-01-01GREG ACKERSON2021-10-11 GREG ACKERSON2021-10-11
0012019-01-01
0012018-02-01

Plan Statistics for WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN

401k plan membership statisitcs for WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN

Measure Date Value
2022: WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01239
Total number of active participants reported on line 7a of the Form 55002022-01-01307
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0136
Total of all active and inactive participants2022-01-01343
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01343
Number of participants with account balances2022-01-01215
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01105
Total number of active participants reported on line 7a of the Form 55002021-01-01218
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0121
Total of all active and inactive participants2021-01-01239
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01239
Number of participants with account balances2021-01-01141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2019: WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01105
Total number of active participants reported on line 7a of the Form 55002019-01-0184
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-017
Total of all active and inactive participants2019-01-0192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0192
Number of participants with account balances2019-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01124
Total number of active participants reported on line 7a of the Form 55002018-02-01107
Number of retired or separated participants receiving benefits2018-02-010
Number of other retired or separated participants entitled to future benefits2018-02-012
Total of all active and inactive participants2018-02-01109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-02-010
Total participants2018-02-01109
Number of participants with account balances2018-02-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-02-013

Financial Data on WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN

Measure Date Value
2022 : WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$2,406,598
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$324,683
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$307,036
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$3,053,103
Value of total assets at end of year2022-12-31$5,232,908
Value of total assets at beginning of year2022-12-31$3,150,993
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$17,647
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,449,544
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$675,548
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$2,081,915
Value of net assets at end of year (total assets less liabilities)2022-12-31$5,232,908
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,150,993
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$16,527
Value of interest in pooled separate accounts at end of year2022-12-31$5,232,908
Value of interest in pooled separate accounts at beginning of year2022-12-31$3,150,993
Net investment gain/loss from pooled separate accounts2022-12-31$-646,505
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$928,011
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$307,036
Contract administrator fees2022-12-31$1,120
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31CLARK SCHAEFER HACKETT
Accountancy firm EIN2022-12-31310800053
2021 : WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,668,396
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$236,062
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$225,320
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,335,832
Value of total assets at end of year2021-12-31$3,150,993
Value of total assets at beginning of year2021-12-31$1,718,659
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$10,742
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$733,366
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$193,948
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,432,334
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,150,993
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,718,659
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$10,102
Value of interest in pooled separate accounts at end of year2021-12-31$3,150,993
Value of interest in pooled separate accounts at beginning of year2021-12-31$1,654,171
Net investment gain/loss from pooled separate accounts2021-12-31$332,564
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$408,518
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$64,488
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$225,320
Contract administrator fees2021-12-31$640
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CLARK SCHAEFER HACKETT
Accountancy firm EIN2021-12-31310800053
2019 : WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2019 401k financial data
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 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$246,624
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$57,675
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$57,332
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$179,610
Value of total assets at end of year2019-12-31$387,273
Value of total assets at beginning of year2019-12-31$198,324
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$343
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$100
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
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
Contributions received from participants2019-12-31$179,610
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$188,949
Value of net assets at end of year (total assets less liabilities)2019-12-31$387,273
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$198,324
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 leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$63
Value of interest in pooled separate accounts at end of year2019-12-31$387,273
Value of interest in pooled separate accounts at beginning of year2019-12-31$198,324
Net investment gain/loss from pooled separate accounts2019-12-31$67,014
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
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$57,332
Contract administrator fees2019-12-31$180
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
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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31CLARK SCHAEFER HACKETT & CO
Accountancy firm EIN2019-12-31310800053
2018 : WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$201,902
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$3,578
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$3,510
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$219,706
Value of total assets at end of year2018-12-31$198,324
Value of total assets at beginning of year2018-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$68
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$213,294
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$6,412
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$198,324
Value of net assets at end of year (total assets less liabilities)2018-12-31$198,324
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in pooled separate accounts at end of year2018-12-31$198,324
Net investment gain/loss from pooled separate accounts2018-12-31$-17,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$3,510
Contract administrator fees2018-12-31$68
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31CLARK, SCHAEFER, HACKET & CO
Accountancy firm EIN2018-12-31310800053

Form 5500 Responses for WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN

2022: WORKHORSE TECHNOLOGIES, INC. 401(K) 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 – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: WORKHORSE TECHNOLOGIES, 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 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
2019: WORKHORSE TECHNOLOGIES, 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
2018: WORKHORSE TECHNOLOGIES, INC. 401(K) PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01First time form 5500 has been submittedYes
2018-02-01Submission has been amendedNo
2018-02-01This submission is the final filingNo
2018-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-02-01Plan is a collectively bargained planNo
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan funding arrangement – TrustYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan 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 number132942
Policy instance 1
Insurance contract or identification number132942
Number of Individuals Covered241
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,888
Total amount of fees paid to insurance companyUSD $595
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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 $1,888
Amount paid for insurance broker fees595
Additional information about fees paid to insurance brokerTPA 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 number132942
Policy instance 1
Insurance contract or identification number132942
Number of Individuals Covered151
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,142
Total amount of fees paid to insurance companyUSD $415
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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 $1,142
Amount paid for insurance broker fees415
Additional information about fees paid to insurance brokerTPA 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 number132942
Policy instance 1
Insurance contract or identification number132942
Number of Individuals Covered56
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,497
Total amount of fees paid to insurance companyUSD $1,146
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
Commission paid to Insurance BrokerUSD $1,497
Insurance broker organization code?4
Amount paid for insurance broker fees1146
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 number132942
Policy instance 1
Insurance contract or identification number132942
Number of Individuals Covered29
Insurance policy start date2018-04-18
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $369
Total amount of fees paid to insurance companyUSD $1,977
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
Commission paid to Insurance BrokerUSD $369
Insurance broker organization code?4
Amount paid for insurance broker fees1977
Additional information about fees paid to insurance brokerTPA COMPENSATION

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