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RYAN MICHELSON 401(K) PLAN 401k Plan overview

Plan NameRYAN MICHELSON 401(K) PLAN
Plan identification number 001

RYAN MICHELSON 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

RYAN MICHELSON, DDS has sponsored the creation of one or more 401k plans.

Company Name:RYAN MICHELSON, DDS
Employer identification number (EIN):274823513
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RYAN MICHELSON 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
0012018-01-01RYAN MICHELSON, DDS
0012017-01-01RYAN MICHELSON, DDS
0012016-01-01RYAN MICHELSON, DDS
0012015-01-01RYAN MICHELSON, DDS
0012014-01-01RYAN MICHELSON, DDS
0012013-01-01RYAN MICHELSON, DDS RYAN MICHELSON, DDS2014-07-23
0012012-01-01RYAN MICHELSON, DDS RYAN MICHELSON, DDS2013-07-23

Plan Statistics for RYAN MICHELSON 401(K) PLAN

401k plan membership statisitcs for RYAN MICHELSON 401(K) PLAN

Measure Date Value
2022: RYAN MICHELSON 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0112
Total number of active participants reported on line 7a of the Form 55002022-01-0112
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-011
Total of all active and inactive participants2022-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0113
Number of participants with account balances2022-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: RYAN MICHELSON 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0110
Total number of active participants reported on line 7a of the Form 55002021-01-0110
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0110
Number of participants with account balances2021-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: RYAN MICHELSON 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-017
Total number of active participants reported on line 7a of the Form 55002020-01-019
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-019
Number of participants with account balances2020-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: RYAN MICHELSON 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0110
Total number of active participants reported on line 7a of the Form 55002019-01-017
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-011
Total of all active and inactive participants2019-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-018
Number of participants with account balances2019-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: RYAN MICHELSON 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0110
Total number of active participants reported on line 7a of the Form 55002018-01-0110
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0110
Number of participants with account balances2018-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: RYAN MICHELSON 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0112
Total number of active participants reported on line 7a of the Form 55002017-01-019
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-019
Number of participants with account balances2017-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: RYAN MICHELSON 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0114
Total number of active participants reported on line 7a of the Form 55002016-01-0110
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-012
Total of all active and inactive participants2016-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0112
Number of participants with account balances2016-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: RYAN MICHELSON 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0113
Total number of active participants reported on line 7a of the Form 55002015-01-0114
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0114
Number of participants with account balances2015-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: RYAN MICHELSON 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-017
Total number of active participants reported on line 7a of the Form 55002014-01-018
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-018
Number of participants with account balances2014-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: RYAN MICHELSON 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-016
Total number of active participants reported on line 7a of the Form 55002013-01-016
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-016
Number of participants with account balances2013-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: RYAN MICHELSON 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-010
Total number of active participants reported on line 7a of the Form 55002012-01-016
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-016
Number of participants with account balances2012-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on RYAN MICHELSON 401(K) PLAN

Measure Date Value
2022 : RYAN MICHELSON 401(K) PLAN 2022 401k financial data
Total income from all sources2022-12-31$-61,009
Expenses. Total of all expenses incurred2022-12-31$113,115
Benefits paid (including direct rollovers)2022-12-31$110,283
Total plan assets at end of year2022-12-31$619,899
Total plan assets at beginning of year2022-12-31$794,023
Value of fidelity bond covering the plan2022-12-31$100,000
Total contributions received or receivable from participants2022-12-31$64,735
Other income received2022-12-31$-143,861
Net income (gross income less expenses)2022-12-31$-174,124
Net plan assets at end of year (total assets less liabilities)2022-12-31$619,899
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$794,023
Total contributions received or receivable from employer(s)2022-12-31$18,117
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$2,832
2021 : RYAN MICHELSON 401(K) PLAN 2021 401k financial data
Total income from all sources2021-12-31$167,078
Expenses. Total of all expenses incurred2021-12-31$3,048
Benefits paid (including direct rollovers)2021-12-31$0
Total plan assets at end of year2021-12-31$794,023
Total plan assets at beginning of year2021-12-31$629,993
Value of fidelity bond covering the plan2021-12-31$100,000
Total contributions received or receivable from participants2021-12-31$61,622
Contributions received from other sources (not participants or employers)2021-12-31$0
Other income received2021-12-31$91,178
Net income (gross income less expenses)2021-12-31$164,030
Net plan assets at end of year (total assets less liabilities)2021-12-31$794,023
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$629,993
Total contributions received or receivable from employer(s)2021-12-31$14,278
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$3,048
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : RYAN MICHELSON 401(K) PLAN 2020 401k financial data
Total income from all sources2020-12-31$156,377
Expenses. Total of all expenses incurred2020-12-31$255,589
Benefits paid (including direct rollovers)2020-12-31$252,859
Total plan assets at end of year2020-12-31$629,993
Total plan assets at beginning of year2020-12-31$729,205
Value of fidelity bond covering the plan2020-12-31$100,000
Total contributions received or receivable from participants2020-12-31$58,656
Other income received2020-12-31$78,537
Net income (gross income less expenses)2020-12-31$-99,212
Net plan assets at end of year (total assets less liabilities)2020-12-31$629,993
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$729,205
Total contributions received or receivable from employer(s)2020-12-31$19,184
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$2,730
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : RYAN MICHELSON 401(K) PLAN 2019 401k financial data
Total income from all sources2019-12-31$205,219
Expenses. Total of all expenses incurred2019-12-31$19,608
Benefits paid (including direct rollovers)2019-12-31$16,707
Total plan assets at end of year2019-12-31$729,205
Total plan assets at beginning of year2019-12-31$543,594
Value of fidelity bond covering the plan2019-12-31$100,000
Total contributions received or receivable from participants2019-12-31$62,160
Other income received2019-12-31$126,221
Net income (gross income less expenses)2019-12-31$185,611
Net plan assets at end of year (total assets less liabilities)2019-12-31$729,205
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$543,594
Total contributions received or receivable from employer(s)2019-12-31$16,838
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$2,901
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : RYAN MICHELSON 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$35,342
Expenses. Total of all expenses incurred2018-12-31$2,545
Total plan assets at end of year2018-12-31$543,594
Total plan assets at beginning of year2018-12-31$510,797
Value of fidelity bond covering the plan2018-12-31$70,000
Total contributions received or receivable from participants2018-12-31$73,465
Other income received2018-12-31$-56,927
Net income (gross income less expenses)2018-12-31$32,797
Net plan assets at end of year (total assets less liabilities)2018-12-31$543,594
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$510,797
Total contributions received or receivable from employer(s)2018-12-31$18,804
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$2,545
2017 : RYAN MICHELSON 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$162,224
Expenses. Total of all expenses incurred2017-12-31$30,321
Benefits paid (including direct rollovers)2017-12-31$27,923
Total plan assets at end of year2017-12-31$510,797
Total plan assets at beginning of year2017-12-31$378,894
Value of fidelity bond covering the plan2017-12-31$70,000
Total contributions received or receivable from participants2017-12-31$66,948
Other income received2017-12-31$79,333
Net income (gross income less expenses)2017-12-31$131,903
Net plan assets at end of year (total assets less liabilities)2017-12-31$510,797
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$378,894
Total contributions received or receivable from employer(s)2017-12-31$15,943
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$2,398
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : RYAN MICHELSON 401(K) PLAN 2016 401k financial data
Total income from all sources2016-12-31$121,722
Expenses. Total of all expenses incurred2016-12-31$52,466
Benefits paid (including direct rollovers)2016-12-31$50,488
Total plan assets at end of year2016-12-31$378,894
Total plan assets at beginning of year2016-12-31$309,638
Value of fidelity bond covering the plan2016-12-31$25,000
Total contributions received or receivable from participants2016-12-31$67,786
Other income received2016-12-31$28,495
Net income (gross income less expenses)2016-12-31$69,256
Net plan assets at end of year (total assets less liabilities)2016-12-31$378,894
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$309,638
Total contributions received or receivable from employer(s)2016-12-31$25,441
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$1,978
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : RYAN MICHELSON 401(K) PLAN 2015 401k financial data
Total income from all sources2015-12-31$84,015
Expenses. Total of all expenses incurred2015-12-31$1,583
Total plan assets at end of year2015-12-31$309,638
Total plan assets at beginning of year2015-12-31$227,206
Value of fidelity bond covering the plan2015-12-31$25,000
Total contributions received or receivable from participants2015-12-31$77,000
Other income received2015-12-31$-8,342
Net income (gross income less expenses)2015-12-31$82,432
Net plan assets at end of year (total assets less liabilities)2015-12-31$309,638
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$227,206
Total contributions received or receivable from employer(s)2015-12-31$15,357
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$1,583
2014 : RYAN MICHELSON 401(K) PLAN 2014 401k financial data
Total income from all sources2014-12-31$60,674
Expenses. Total of all expenses incurred2014-12-31$1,155
Benefits paid (including direct rollovers)2014-12-31$0
Total plan assets at end of year2014-12-31$227,206
Total plan assets at beginning of year2014-12-31$167,687
Value of fidelity bond covering the plan2014-12-31$25,000
Total contributions received or receivable from participants2014-12-31$37,198
Other income received2014-12-31$8,460
Net income (gross income less expenses)2014-12-31$59,519
Net plan assets at end of year (total assets less liabilities)2014-12-31$227,206
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$167,687
Total contributions received or receivable from employer(s)2014-12-31$15,016
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$1,155
2013 : RYAN MICHELSON 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$108,050
Expenses. Total of all expenses incurred2013-12-31$2,257
Total plan assets at end of year2013-12-31$167,687
Total plan assets at beginning of year2013-12-31$61,894
Value of fidelity bond covering the plan2013-12-31$25,000
Total contributions received or receivable from participants2013-12-31$46,309
Contributions received from other sources (not participants or employers)2013-12-31$28,357
Other income received2013-12-31$20,456
Net income (gross income less expenses)2013-12-31$105,793
Net plan assets at end of year (total assets less liabilities)2013-12-31$167,687
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$61,894
Total contributions received or receivable from employer(s)2013-12-31$12,928
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$2,257
2012 : RYAN MICHELSON 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$62,223
Expenses. Total of all expenses incurred2012-12-31$329
Total plan assets at end of year2012-12-31$61,894
Total plan assets at beginning of year2012-12-31$0
Value of fidelity bond covering the plan2012-12-31$25,000
Total contributions received or receivable from participants2012-12-31$43,116
Contributions received from other sources (not participants or employers)2012-12-31$9,864
Other income received2012-12-31$3,419
Net income (gross income less expenses)2012-12-31$61,894
Net plan assets at end of year (total assets less liabilities)2012-12-31$61,894
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$5,824
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$329

Form 5500 Responses for RYAN MICHELSON 401(K) PLAN

2022: RYAN MICHELSON 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: RYAN MICHELSON 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: RYAN MICHELSON 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: RYAN MICHELSON 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 benefit arrangement – InsuranceYes
2018: RYAN MICHELSON 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 benefit arrangement – InsuranceYes
2017: RYAN MICHELSON 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: RYAN MICHELSON 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 benefit arrangement – InsuranceYes
2015: RYAN MICHELSON 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 benefit arrangement – InsuranceYes
2014: RYAN MICHELSON 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 benefit arrangement – InsuranceYes
2013: RYAN MICHELSON 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
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 benefit arrangement – InsuranceYes
2012: RYAN MICHELSON 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104435
Policy instance 1
Insurance contract or identification number104435
Number of Individuals Covered13
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,274
Total amount of fees paid to insurance companyUSD $50
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $3,274
Insurance broker organization code?3
Amount paid for insurance broker fees50
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104435
Policy instance 1
Insurance contract or identification number104435
Number of Individuals Covered11
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,563
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $3,563
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104435
Policy instance 1
Insurance contract or identification number104435
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,143
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $3,143
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104435
Policy instance 1
Insurance contract or identification number104435
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,219
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $3,219
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104435
Policy instance 1
Insurance contract or identification number104435
Number of Individuals Covered10
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,784
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $2,784
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number104435
Policy instance 1
Insurance contract or identification number104435
Number of Individuals Covered9
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,235
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $2,235
Insurance broker organization code?3
Insurance broker name

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