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PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 401k Plan overview

Plan NamePENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT
Plan identification number 001

PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT Benefits

401k Plan TypeDefined Benefit Pension
Plan Features/Benefits
  • Benefits are primarily flat dollar (includes dollars per year of service)
  • Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
  • Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
  • Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

LYONDELLBASELL ACETYLS, LLC has sponsored the creation of one or more 401k plans.

Company Name:LYONDELLBASELL ACETYLS, LLC
Employer identification number (EIN):271191233
NAIC Classification:325100

Additional information about LYONDELLBASELL ACETYLS, LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2009-11-19
Company Identification Number: 0801196716
Legal Registered Office Address: PO BOX 3205

HOUSTON
United States of America (USA)
77253

More information about LYONDELLBASELL ACETYLS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-06-01REBECCA PATTERSON HOLMES
0012016-06-01REBECCA PATTERSON HOLMES
0012015-06-01REBECCA PATTERSON HOLMES
0012014-06-01TIMOTHY MCMAHON
0012013-06-01PEGGY PFISTER
0012012-06-01PEGGY PFISTER
0012011-06-01PEGGY PFISTER PEGGY PFISTER2013-03-13
0012010-06-01MARIE-CLAIRE ABELANET MARIE-CLAIRE ABELANET2012-03-13
0012009-06-01MARIE-CLAIRE ABELANET MARIE-CLAIRE ABELANET2011-03-15

Plan Statistics for PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT

401k plan membership statisitcs for PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT

Measure Date Value
2017: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2017 401k membership
Total participants, beginning-of-year2017-06-010
Total number of active participants reported on line 7a of the Form 55002017-06-010
Number of retired or separated participants receiving benefits2017-06-010
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-06-010
Total participants2017-06-010
2016: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2016 401k membership
Total participants, beginning-of-year2016-06-0120
Total number of active participants reported on line 7a of the Form 55002016-06-010
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-06-010
Total participants2016-06-010
2015: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2015 401k membership
Total participants, beginning-of-year2015-06-0120
Total number of active participants reported on line 7a of the Form 55002015-06-010
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-0120
Total of all active and inactive participants2015-06-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-06-010
Total participants2015-06-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-06-010
2014: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2014 401k membership
Total participants, beginning-of-year2014-06-0121
Total number of active participants reported on line 7a of the Form 55002014-06-010
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-0120
Total of all active and inactive participants2014-06-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-06-010
Total participants2014-06-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-06-010
2013: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2013 401k membership
Total participants, beginning-of-year2013-06-0123
Total number of active participants reported on line 7a of the Form 55002013-06-010
Number of retired or separated participants receiving benefits2013-06-010
Number of other retired or separated participants entitled to future benefits2013-06-0121
Total of all active and inactive participants2013-06-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-06-010
Total participants2013-06-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-06-010
2012: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2012 401k membership
Total participants, beginning-of-year2012-06-0123
Total number of active participants reported on line 7a of the Form 55002012-06-010
Number of retired or separated participants receiving benefits2012-06-010
Number of other retired or separated participants entitled to future benefits2012-06-0123
Total of all active and inactive participants2012-06-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-06-010
Total participants2012-06-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-06-010
2011: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2011 401k membership
Total participants, beginning-of-year2011-06-0126
Total number of active participants reported on line 7a of the Form 55002011-06-010
Number of retired or separated participants receiving benefits2011-06-010
Number of other retired or separated participants entitled to future benefits2011-06-0123
Total of all active and inactive participants2011-06-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-06-010
Total participants2011-06-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-06-010
2010: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2010 401k membership
Total participants, beginning-of-year2010-06-0128
Total number of active participants reported on line 7a of the Form 55002010-06-010
Number of retired or separated participants receiving benefits2010-06-010
Number of other retired or separated participants entitled to future benefits2010-06-0123
Total of all active and inactive participants2010-06-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-06-013
Total participants2010-06-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-06-010
2009: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2009 401k membership
Total participants, beginning-of-year2009-06-0129
Total number of active participants reported on line 7a of the Form 55002009-06-010
Number of retired or separated participants receiving benefits2009-06-010
Number of other retired or separated participants entitled to future benefits2009-06-0124
Total of all active and inactive participants2009-06-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-06-014
Total participants2009-06-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-06-010

Financial Data on PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT

Measure Date Value
2017 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2017 401k financial data
Total income from all sources2017-06-30$0
Expenses. Total of all expenses incurred2017-06-30$94,312
Benefits paid (including direct rollovers)2017-06-30$94,312
Total plan assets at end of year2017-06-30$0
Total plan assets at beginning of year2017-06-30$94,312
Value of fidelity bond covering the plan2017-06-30$52,300,000
Net income (gross income less expenses)2017-06-30$-94,312
Net plan assets at end of year (total assets less liabilities)2017-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$94,312
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-06-30$0
Total income from all sources2017-05-31$293,763
Expenses. Total of all expenses incurred2017-05-31$628,650
Benefits paid (including direct rollovers)2017-05-31$620,895
Total plan assets at end of year2017-05-31$94,312
Total plan assets at beginning of year2017-05-31$429,199
Value of fidelity bond covering the plan2017-05-31$52,300,000
Expenses. Other expenses not covered elsewhere2017-05-31$7,755
Other income received2017-05-31$14,699
Net income (gross income less expenses)2017-05-31$-334,887
Net plan assets at end of year (total assets less liabilities)2017-05-31$94,312
Net plan assets at beginning of year (total assets less liabilities)2017-05-31$429,199
Total contributions received or receivable from employer(s)2017-05-31$279,064
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-05-31$0
2016 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2016 401k financial data
Total income from all sources2016-05-31$30,642
Expenses. Total of all expenses incurred2016-05-31$12,869
Total plan assets at end of year2016-05-31$429,199
Total plan assets at beginning of year2016-05-31$411,426
Value of fidelity bond covering the plan2016-05-31$54,333,000
Expenses. Other expenses not covered elsewhere2016-05-31$12,869
Other income received2016-05-31$11,852
Net income (gross income less expenses)2016-05-31$17,773
Net plan assets at end of year (total assets less liabilities)2016-05-31$429,199
Net plan assets at beginning of year (total assets less liabilities)2016-05-31$411,426
Total contributions received or receivable from employer(s)2016-05-31$18,790
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-05-31$0
2015 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2015 401k financial data
Total income from all sources2015-05-31$30,597
Expenses. Total of all expenses incurred2015-05-31$77,321
Benefits paid (including direct rollovers)2015-05-31$63,798
Total plan assets at end of year2015-05-31$411,426
Total plan assets at beginning of year2015-05-31$458,150
Value of fidelity bond covering the plan2015-05-31$60,775,000
Expenses. Other expenses not covered elsewhere2015-05-31$13,523
Other income received2015-05-31$1,197
Net income (gross income less expenses)2015-05-31$-46,724
Net plan assets at end of year (total assets less liabilities)2015-05-31$411,426
Net plan assets at beginning of year (total assets less liabilities)2015-05-31$458,150
Total contributions received or receivable from employer(s)2015-05-31$29,400
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-05-31$0
2014 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2014 401k financial data
Total income from all sources2014-05-31$33,909
Expenses. Total of all expenses incurred2014-05-31$29,996
Benefits paid (including direct rollovers)2014-05-31$18,148
Total plan assets at end of year2014-05-31$458,150
Total plan assets at beginning of year2014-05-31$454,237
Value of fidelity bond covering the plan2014-05-31$68,875,000
Expenses. Other expenses not covered elsewhere2014-05-31$11,848
Other income received2014-05-31$12,452
Net income (gross income less expenses)2014-05-31$3,913
Net plan assets at end of year (total assets less liabilities)2014-05-31$458,150
Net plan assets at beginning of year (total assets less liabilities)2014-05-31$454,237
Total contributions received or receivable from employer(s)2014-05-31$21,457
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-05-31$0
2013 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2013 401k financial data
Total income from all sources2013-05-31$18,745
Expenses. Total of all expenses incurred2013-05-31$10,706
Total plan assets at end of year2013-05-31$454,237
Total plan assets at beginning of year2013-05-31$446,198
Value of fidelity bond covering the plan2013-05-31$65,945,000
Expenses. Other expenses not covered elsewhere2013-05-31$10,706
Other income received2013-05-31$12,683
Net income (gross income less expenses)2013-05-31$8,039
Net plan assets at end of year (total assets less liabilities)2013-05-31$454,237
Net plan assets at beginning of year (total assets less liabilities)2013-05-31$446,198
Total contributions received or receivable from employer(s)2013-05-31$6,062
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-05-31$0
2012 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2012 401k financial data
Total income from all sources2012-05-31$24,888
Expenses. Total of all expenses incurred2012-05-31$7,018
Total plan assets at end of year2012-05-31$446,198
Total plan assets at beginning of year2012-05-31$428,328
Value of fidelity bond covering the plan2012-05-31$51,756,000
Expenses. Other expenses not covered elsewhere2012-05-31$7,018
Other income received2012-05-31$12,138
Net income (gross income less expenses)2012-05-31$17,870
Net plan assets at end of year (total assets less liabilities)2012-05-31$446,198
Net plan assets at beginning of year (total assets less liabilities)2012-05-31$428,328
Total contributions received or receivable from employer(s)2012-05-31$12,750
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-05-31$0
2011 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2011 401k financial data
Total income from all sources2011-05-31$13,305
Expenses. Total of all expenses incurred2011-05-31$50,720
Benefits paid (including direct rollovers)2011-05-31$38,957
Total plan assets at end of year2011-05-31$428,328
Total plan assets at beginning of year2011-05-31$465,743
Value of fidelity bond covering the plan2011-05-31$56,000,000
Expenses. Other expenses not covered elsewhere2011-05-31$11,763
Other income received2011-05-31$13,305
Net income (gross income less expenses)2011-05-31$-37,415
Net plan assets at end of year (total assets less liabilities)2011-05-31$428,328
Net plan assets at beginning of year (total assets less liabilities)2011-05-31$465,743
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-05-31$0
2010 : PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-05-31$0

Form 5500 Responses for PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT

2017: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingYes
2017-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-06-01Plan is a collectively bargained planYes
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – TrustYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement - TrustYes
2016: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planYes
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – TrustYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement - TrustYes
2015: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planYes
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – TrustYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement - TrustYes
2014: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planYes
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – TrustYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement - TrustYes
2013: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planYes
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – TrustYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement - TrustYes
2012: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planYes
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – TrustYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement - TrustYes
2011: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planYes
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – TrustYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement - TrustYes
2010: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedNo
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)No
2010-06-01Plan is a collectively bargained planYes
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – TrustYes
2010-06-01Plan benefit arrangement – InsuranceYes
2010-06-01Plan benefit arrangement - TrustYes
2009: PENSION PLAN FOR ELIGIBLE HOURLY EMPLOYEES OF THE QUANTUM CHEMICAL CORPORATION, USI DIVISION, NORTECH PLANT 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planYes
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – TrustYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan 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 numberGAC 1871 ASSN 0
Policy instance 1
Insurance contract or identification numberGAC 1871 ASSN 0
Number of Individuals Covered23
Insurance policy start date2017-06-01
Insurance policy end date2017-06-30
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 Administration1
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 numberGAC 1871 ASSN 0
Policy instance 1
Insurance contract or identification numberGAC 1871 ASSN 0
Number of Individuals Covered19
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
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 Administration1
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 numberGAC 1871 ASSN 0
Policy instance 1
Insurance contract or identification numberGAC 1871 ASSN 0
Number of Individuals Covered21
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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 numberGAC 1871 ASSN 0
Policy instance 1
Insurance contract or identification numberGAC 1871 ASSN 0
Number of Individuals Covered20
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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 numberGAC 1871 ASSN 0
Policy instance 1
Insurance contract or identification numberGAC 1871 ASSN 0
Number of Individuals Covered21
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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 numberGAC 1871 ASSN 0
Policy instance 1
Insurance contract or identification numberGAC 1871 ASSN 0
Number of Individuals Covered21
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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 numberGAC 1871 ASSN 0
Policy instance 1
Insurance contract or identification numberGAC 1871 ASSN 0
Number of Individuals Covered22
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
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

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