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KASPIEN INC. 401(K) PLAN 401k Plan overview

Plan NameKASPIEN INC. 401(K) PLAN
Plan identification number 001

KASPIEN INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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

KASPIEN INC. has sponsored the creation of one or more 401k plans.

Company Name:KASPIEN INC.
Employer identification number (EIN):262711978
NAIC Classification:454110
NAIC Description:Electronic Shopping and Mail-Order Houses

Additional information about KASPIEN INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 2008-05-30
Company Identification Number: 602836216
Legal Registered Office Address: 2818 N SULLIVAN RD STE 130

SPOKANE VLY
United States of America (USA)
992165198

More information about KASPIEN INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KASPIEN 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
0012019-01-01BROCK KOWALCHUK2020-10-08 BROCK KOWALCHUK2020-10-08
0012019-01-01BROCK KOWALCHUK2020-10-07 BROCK KOWALCHUK2020-10-07
0012018-01-01BROCK KOWALCHUK2019-10-07 BROCK KOWALCHUK2019-10-07
0012017-01-01
0012016-01-01DOMONIQUE PERETTI2017-07-21
0012015-01-01BETH ELFERING2016-03-23

Plan Statistics for KASPIEN INC. 401(K) PLAN

401k plan membership statisitcs for KASPIEN INC. 401(K) PLAN

Measure Date Value
2022: KASPIEN INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01198
Total number of active participants reported on line 7a of the Form 55002022-01-0196
Number of other retired or separated participants entitled to future benefits2022-01-0178
Total of all active and inactive participants2022-01-01174
Total participants2022-01-01174
Number of participants with account balances2022-01-01142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0126
2021: KASPIEN INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01186
Total number of active participants reported on line 7a of the Form 55002021-01-01135
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0163
Total of all active and inactive participants2021-01-01198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01198
Number of participants with account balances2021-01-01150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-013
2020: KASPIEN INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01206
Total number of active participants reported on line 7a of the Form 55002020-01-01132
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0154
Total of all active and inactive participants2020-01-01186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01186
Number of participants with account balances2020-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-012
2019: KASPIEN INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01293
Total number of active participants reported on line 7a of the Form 55002019-01-01152
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0149
Total of all active and inactive participants2019-01-01201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01201
Number of participants with account balances2019-01-01139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-0116
2018: KASPIEN INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01135
Total number of active participants reported on line 7a of the Form 55002018-01-01160
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0124
Total of all active and inactive participants2018-01-01184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01184
Number of participants with account balances2018-01-01134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0112

Financial Data on KASPIEN INC. 401(K) PLAN

Measure Date Value
2022 : KASPIEN INC. 401(K) PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$230,626
Total of all expenses incurred2022-12-31$641,886
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$607,802
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$929,317
Value of total assets at end of year2022-12-31$3,495,443
Value of total assets at beginning of year2022-12-31$3,906,703
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$34,084
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$519,786
Participant contributions at beginning of year2022-12-31$9
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$59,859
Total non interest bearing cash at end of year2022-12-31$13,750
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-411,260
Value of net assets at end of year (total assets less liabilities)2022-12-31$3,495,443
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,906,703
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$3,481,693
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$3,906,694
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-698,691
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$349,672
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$607,802
Contract administrator fees2022-12-31$34,084
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 name2022-12-31DECORIA, BLAIR & TEAGUE, PS
Accountancy firm EIN2022-12-31260152208
2021 : KASPIEN INC. 401(K) PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$1,351,966
Total of all expenses incurred2021-12-31$874,862
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$841,164
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$826,873
Value of total assets at end of year2021-12-31$3,906,703
Value of total assets at beginning of year2021-12-31$3,429,599
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$33,698
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$33,698
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$485,661
Participant contributions at end of year2021-12-31$9
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$24,671
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$477,104
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,906,703
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$3,429,599
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$3,906,694
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$3,429,599
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$525,093
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$316,541
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$841,164
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 name2021-12-31DECORIA, BLAIR & TEAGUE, PS
Accountancy firm EIN2021-12-31260152208
2020 : KASPIEN INC. 401(K) PLAN 2020 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,194
Total income from all sources (including contributions)2020-12-31$1,246,664
Total of all expenses incurred2020-12-31$315,465
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$288,783
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$725,571
Value of total assets at end of year2020-12-31$3,429,599
Value of total assets at beginning of year2020-12-31$2,499,594
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$26,682
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$600
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$423,992
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$36,083
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$1,194
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$931,199
Value of net assets at end of year (total assets less liabilities)2020-12-31$3,429,599
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$2,498,400
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
Investment advisory and management fees2020-12-31$10,561
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$3,429,599
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$2,499,594
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$521,093
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$265,496
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$288,783
Contract administrator fees2020-12-31$15,521
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 name2020-12-31DECORIA, MAICHEL & TEAGUE PS
Accountancy firm EIN2020-12-31911632354
2019 : KASPIEN 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$1,194
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$1,188,957
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$259,369
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$237,104
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$766,085
Value of total assets at end of year2019-12-31$2,499,594
Value of total assets at beginning of year2019-12-31$1,568,812
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$22,265
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$1,300
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
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$451,922
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$2,137
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$1,194
Administrative expenses (other) incurred2019-12-31$0
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$929,588
Value of net assets at end of year (total assets less liabilities)2019-12-31$2,498,400
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,568,812
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$8,096
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$2,499,594
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$1,568,812
Value of interest in pooled separate accounts at end of year2019-12-31$0
Value of interest in pooled separate accounts at beginning of year2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$422,872
Net investment gain/loss from pooled separate accounts2019-12-31$0
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
Contributions received in cash from employer2019-12-31$312,026
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$237,104
Contract administrator fees2019-12-31$12,869
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 name2019-12-31DECORIA, MAICHEL & TEAGUE PS
Accountancy firm EIN2019-12-31911632354
2018 : KASPIEN 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$511,335
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$126,786
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$123,292
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$649,598
Value of total assets at end of year2018-12-31$1,568,812
Value of total assets at beginning of year2018-12-31$1,184,263
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$3,494
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
Administrative expenses professional fees incurred2018-12-31$600
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$358,046
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$1,295
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$384,549
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,568,812
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$1,184,263
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
Investment advisory and management fees2018-12-31$1,051
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$1,568,812
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$1,184,263
Value of interest in pooled separate accounts at end of year2018-12-31$0
Value of interest in pooled separate accounts at beginning of year2018-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-138,263
Net investment gain/loss from pooled separate accounts2018-12-31$0
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 contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$291,552
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$121,997
Contract administrator fees2018-12-31$1,843
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 name2018-12-31DECORIA, MAICHEL & TEAGUE PS
Accountancy firm EIN2018-12-31911632354

Form 5500 Responses for KASPIEN INC. 401(K) PLAN

2022: KASPIEN INC. 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: KASPIEN INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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: KASPIEN INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: KASPIEN 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 - TrustYes
2018: KASPIEN INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan 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 number116402
Policy instance 1
Insurance contract or identification number116402
Number of Individuals Covered146
Total amount of commissions paid to insurance brokerUSD $1,751
Total amount of fees paid to insurance companyUSD $2,775
Commission paid to Insurance BrokerUSD $1,751
Amount paid for insurance broker fees2775
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number116402
Policy instance 1
Insurance contract or identification number116402
Number of Individuals Covered159
Total amount of commissions paid to insurance brokerUSD $1,653
Total amount of fees paid to insurance companyUSD $1,800
Commission paid to Insurance BrokerUSD $1,653
Amount paid for insurance broker fees1800
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number116402
Policy instance 1
Insurance contract or identification number116402
Number of Individuals Covered138
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees450
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 number
Policy instance 1
Number of Individuals Covered137
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,300
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
Amount paid for insurance broker fees1300
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 number
Policy instance 1
Number of Individuals Covered147
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $600
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
Amount paid for insurance broker fees600
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5

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