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PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 401k Plan overview

Plan NamePEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN
Plan identification number 001

PEDIATRIC SURGICAL ASSOCIATES, 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.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

PEDIATRIC SURGICAL ASSOCIATES, INC. has sponsored the creation of one or more 401k plans.

Company Name:PEDIATRIC SURGICAL ASSOCIATES, INC.
Employer identification number (EIN):260425837
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEDIATRIC SURGICAL ASSOCIATES, 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
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01DR. VINH LAM
0012013-01-01DR. VINH LAM
0012012-01-01DR. VINH LAM
0012011-01-01DR. VINH LAM
0012010-01-01DR. DAVID GIBBS
0012009-01-01DR. DAVID GIBBS

Plan Statistics for PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN

401k plan membership statisitcs for PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN

Measure Date Value
2016: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-019
Total number of active participants reported on line 7a of the Form 55002016-01-017
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-013
Total of all active and inactive participants2016-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0110
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: PEDIATRIC SURGICAL ASSOCIATES, 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 55002015-01-016
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-013
Total of all active and inactive participants2015-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-019
Number of participants with account balances2015-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-019
2014: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0113
Total number of active participants reported on line 7a of the Form 55002014-01-019
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-013
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: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0110
Total number of active participants reported on line 7a of the Form 55002013-01-019
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-014
Total of all active and inactive participants2013-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0113
Number of participants with account balances2013-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0111
Total number of active participants reported on line 7a of the Form 55002012-01-015
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-015
Total of all active and inactive participants2012-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0110
Number of participants with account balances2012-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-012
2011: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0111
Total number of active participants reported on line 7a of the Form 55002011-01-0111
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0111
Number of participants with account balances2011-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-011
2010: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0112
Total number of active participants reported on line 7a of the Form 55002010-01-0111
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0111
Number of participants with account balances2010-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0113
Total number of active participants reported on line 7a of the Form 55002009-01-0111
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-012
Total of all active and inactive participants2009-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0113
Number of participants with account balances2009-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN

Measure Date Value
2016 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$161,456
Expenses. Total of all expenses incurred2016-12-31$410,827
Benefits paid (including direct rollovers)2016-12-31$410,827
Total plan assets at end of year2016-12-31$1,044,469
Total plan assets at beginning of year2016-12-31$1,293,840
Value of fidelity bond covering the plan2016-12-31$270,000
Total contributions received or receivable from participants2016-12-31$43,364
Expenses. Other expenses not covered elsewhere2016-12-31$0
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$57,560
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$-249,371
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,044,469
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,293,840
Assets. Value of real-estate (other than employer real property)2016-12-31$74,312
Total contributions received or receivable from employer(s)2016-12-31$60,532
Value of certain deemed distributions of participant loans2016-12-31$0
Value of corrective distributions2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2015 401k financial data
Transfers to/from the plan2015-12-31$0
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$318,637
Expenses. Total of all expenses incurred2015-12-31$504,241
Benefits paid (including direct rollovers)2015-12-31$500,379
Total plan assets at end of year2015-12-31$1,293,840
Total plan assets at beginning of year2015-12-31$1,479,444
Value of fidelity bond covering the plan2015-12-31$270,000
Total contributions received or receivable from participants2015-12-31$76,383
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$115,815
Other income received2015-12-31$8,152
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$-185,604
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,293,840
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,479,444
Assets. Value of real-estate (other than employer real property)2015-12-31$80,216
Total contributions received or receivable from employer(s)2015-12-31$118,287
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$3,862
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$124,647
Expenses. Total of all expenses incurred2014-12-31$395,439
Benefits paid (including direct rollovers)2014-12-31$388,994
Total plan assets at end of year2014-12-31$1,479,444
Total plan assets at beginning of year2014-12-31$1,750,236
Value of fidelity bond covering the plan2014-12-31$270,000
Total contributions received or receivable from participants2014-12-31$73,350
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$42,343
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$-270,792
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,479,444
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,750,236
Assets. Value of participant loans2014-12-31$3,353
Total contributions received or receivable from employer(s)2014-12-31$8,954
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$6,445
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$286,595
Expenses. Total of all expenses incurred2013-12-31$386,962
Benefits paid (including direct rollovers)2013-12-31$384,538
Total plan assets at end of year2013-12-31$1,836,310
Total plan assets at beginning of year2013-12-31$1,936,677
Value of fidelity bond covering the plan2013-12-31$270,000
Total contributions received or receivable from participants2013-12-31$45,137
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$128,862
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$-100,367
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,836,310
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,936,677
Assets. Value of participant loans2013-12-31$4,230
Total contributions received or receivable from employer(s)2013-12-31$112,596
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$2,424
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$180,874
Expenses. Total of all expenses incurred2012-12-31$39,997
Benefits paid (including direct rollovers)2012-12-31$37,648
Total plan assets at end of year2012-12-31$1,936,677
Total plan assets at beginning of year2012-12-31$1,795,800
Value of fidelity bond covering the plan2012-12-31$270,000
Total contributions received or receivable from participants2012-12-31$39,479
Other income received2012-12-31$61,014
Net income (gross income less expenses)2012-12-31$140,877
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,936,677
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,795,800
Assets. Value of participant loans2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$80,381
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$2,349
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2011 401k financial data
Total income from all sources2011-12-31$212,902
Expenses. Total of all expenses incurred2011-12-31$27,903
Benefits paid (including direct rollovers)2011-12-31$22,106
Total plan assets at end of year2011-12-31$1,795,800
Total plan assets at beginning of year2011-12-31$1,610,801
Value of fidelity bond covering the plan2011-12-31$295,000
Total contributions received or receivable from participants2011-12-31$80,027
Contributions received from other sources (not participants or employers)2011-12-31$4,433
Other income received2011-12-31$-19,888
Net income (gross income less expenses)2011-12-31$184,999
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,795,800
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,610,801
Assets. Value of participant loans2011-12-31$8,035
Total contributions received or receivable from employer(s)2011-12-31$148,330
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$5,797
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2010 401k financial data
Total income from all sources2010-12-31$412,463
Expenses. Total of all expenses incurred2010-12-31$59,533
Benefits paid (including direct rollovers)2010-12-31$59,533
Total plan assets at end of year2010-12-31$1,610,801
Total plan assets at beginning of year2010-12-31$1,257,871
Value of fidelity bond covering the plan2010-12-31$265,000
Total contributions received or receivable from participants2010-12-31$102,308
Other income received2010-12-31$141,786
Net income (gross income less expenses)2010-12-31$352,930
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,610,801
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,257,871
Assets. Value of participant loans2010-12-31$10,917
Total contributions received or receivable from employer(s)2010-12-31$168,369
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN

2016: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) 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 – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) 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 – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
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: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
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
2012: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: PEDIATRIC SURGICAL ASSOCIATES, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number71102693
Policy instance 1
Insurance contract or identification number71102693
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,653
Total amount of fees paid to insurance companyUSD $0
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 $10,653
Insurance broker organization code?3
Insurance broker nameANDREW KARLINSKI, AK FINANCIAL
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract number71102693
Policy instance 1
Insurance contract or identification number71102693
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $18,892
Total amount of fees paid to insurance companyUSD $0
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 $18,892
Insurance broker organization code?3
Insurance broker nameANDREW KARLINSKI, AK FINANCIAL
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number2702434
Policy instance 1
Insurance contract or identification number2702434
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $791
Total amount of fees paid to insurance companyUSD $0
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 $791
Insurance broker organization code?3
Insurance broker nameANDREW KARLINSKI, AK FINANCIAL
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number2702434
Policy instance 1
Insurance contract or identification number2702434
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,349
Total amount of fees paid to insurance companyUSD $0
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 $2,349
Insurance broker organization code?3
Insurance broker nameANDREW KARLINSKI, AK FINANCIAL
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number2702434
Policy instance 1
Insurance contract or identification number2702434
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,186
Total amount of fees paid to insurance companyUSD $0
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number2702434
Policy instance 1
Insurance contract or identification number2702434
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,684
Total amount of fees paid to insurance companyUSD $0
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 $1,684
Insurance broker organization code?3
Insurance broker nameANDREW KARLINSKI, AK FINANCIAL

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