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MARTIS CAMP CLUB 401(K) PLAN 401k Plan overview

Plan NameMARTIS CAMP CLUB 401(K) PLAN
Plan identification number 001

MARTIS CAMP CLUB 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

MARTIS CAMP CLUB has sponsored the creation of one or more 401k plans.

Company Name:MARTIS CAMP CLUB
Employer identification number (EIN):320178033
NAIC Classification:531390
NAIC Description:Other Activities Related to Real Estate

Additional information about MARTIS CAMP CLUB

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C2791314

More information about MARTIS CAMP CLUB

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARTIS CAMP CLUB 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01KRISTINE EBNER2023-10-10 KRISTINE EBNER2023-10-10
0012021-01-01KRISTINE EBNER2022-10-10 KRISTINE EBNER2022-10-10
0012020-01-01KATE TYLER2021-10-08 MARK JOHNSON2021-10-11
0012019-01-01KATE TYLER2020-10-09 MARK JOHNSON2020-10-13

Plan Statistics for MARTIS CAMP CLUB 401(K) PLAN

401k plan membership statisitcs for MARTIS CAMP CLUB 401(K) PLAN

Measure Date Value
2022: MARTIS CAMP CLUB 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01133
Total number of active participants reported on line 7a of the Form 55002022-01-01115
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0128
Total of all active and inactive participants2022-01-01143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01143
Number of participants with account balances2022-01-0191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-018
2021: MARTIS CAMP CLUB 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01117
Total number of active participants reported on line 7a of the Form 55002021-01-01108
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0123
Total of all active and inactive participants2021-01-01131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01131
Number of participants with account balances2021-01-0186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-013
2020: MARTIS CAMP CLUB 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01112
Total number of active participants reported on line 7a of the Form 55002020-01-0192
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0123
Total of all active and inactive participants2020-01-01115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01115
Number of participants with account balances2020-01-0181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-015
2019: MARTIS CAMP CLUB 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01104
Total number of active participants reported on line 7a of the Form 55002019-01-0192
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0116
Total of all active and inactive participants2019-01-01108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01108
Number of participants with account balances2019-01-0177
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-012

Financial Data on MARTIS CAMP CLUB 401(K) PLAN

Measure Date Value
2022 : MARTIS CAMP CLUB 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$29
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-7,056
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$619,712
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$584,190
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,041,202
Value of total assets at end of year2022-12-31$5,697,961
Value of total assets at beginning of year2022-12-31$6,324,700
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$35,522
Total interest from all sources2022-12-31$4,423
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$484,181
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$143,619
Assets. Loans (other than to participants) at end of year2022-12-31$129,287
Assets. Loans (other than to participants) at beginning of year2022-12-31$96,015
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$29
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Administrative expenses (other) incurred2022-12-31$1,800
Total non interest bearing cash at end of year2022-12-31$3,442
Total non interest bearing cash at beginning of year2022-12-31$2,498
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-626,768
Value of net assets at end of year (total assets less liabilities)2022-12-31$5,697,932
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$6,324,700
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$13,356
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$5,151,830
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$5,856,863
Interest on participant loans2022-12-31$4,423
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,052,681
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$413,402
Employer contributions (assets) at end of year2022-12-31$413,402
Employer contributions (assets) at beginning of year2022-12-31$369,324
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$584,190
Contract administrator fees2022-12-31$20,366
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 name2022-12-31MCCLINTOCK ACCOUNTANCY CORPORATION
Accountancy firm EIN2022-12-31942617724
2021 : MARTIS CAMP CLUB 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,490,628
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$433,630
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$397,085
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$858,762
Value of total assets at end of year2021-12-31$6,324,700
Value of total assets at beginning of year2021-12-31$5,267,702
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$36,545
Total interest from all sources2021-12-31$5,205
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$466,054
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$23,769
Assets. Loans (other than to participants) at end of year2021-12-31$96,015
Assets. Loans (other than to participants) at beginning of year2021-12-31$126,240
Administrative expenses (other) incurred2021-12-31$1,950
Total non interest bearing cash at end of year2021-12-31$2,498
Total non interest bearing cash at beginning of year2021-12-31$31
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,056,998
Value of net assets at end of year (total assets less liabilities)2021-12-31$6,324,700
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$5,267,702
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$13,753
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$5,856,863
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$4,827,677
Interest on participant loans2021-12-31$5,205
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$626,661
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$368,939
Employer contributions (assets) at end of year2021-12-31$369,324
Employer contributions (assets) at beginning of year2021-12-31$313,754
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$397,085
Contract administrator fees2021-12-31$20,842
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 name2021-12-31MCCLINTOCK ACCOUNTANCY CORPORATION
Accountancy firm EIN2021-12-31942617724
2020 : MARTIS CAMP CLUB 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,284,648
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$221,516
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$194,040
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$688,810
Value of total assets at end of year2020-12-31$5,267,702
Value of total assets at beginning of year2020-12-31$4,204,570
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$27,476
Total interest from all sources2020-12-31$5,608
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$362,106
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$14,076
Assets. Loans (other than to participants) at end of year2020-12-31$126,240
Assets. Loans (other than to participants) at beginning of year2020-12-31$107,065
Administrative expenses (other) incurred2020-12-31$27,476
Total non interest bearing cash at end of year2020-12-31$31
Total non interest bearing cash at beginning of year2020-12-31$7,586
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$1,063,132
Value of net assets at end of year (total assets less liabilities)2020-12-31$5,267,702
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$4,204,570
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$4,827,677
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$3,831,854
Interest on participant loans2020-12-31$5,608
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$590,230
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$312,628
Employer contributions (assets) at end of year2020-12-31$313,754
Employer contributions (assets) at beginning of year2020-12-31$258,065
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$194,040
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 name2020-12-31MCCLINTOCK ACCOUNTANCY CORPORATION
Accountancy firm EIN2020-12-31942617724
2019 : MARTIS CAMP CLUB 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets to this plan2019-12-31$3,391,430
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,009,505
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$196,365
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$174,600
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$599,849
Value of total assets at end of year2019-12-31$4,204,570
Value of total assets at beginning of year2019-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$21,765
Total interest from all sources2019-12-31$5,716
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
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$420,457
If this is an individual account plan, was there a blackout period2019-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$287,742
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$54,042
Assets. Loans (other than to participants) at end of year2019-12-31$107,065
Assets. Loans (other than to participants) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$9
Administrative expenses (other) incurred2019-12-31$21,765
Total non interest bearing cash at end of year2019-12-31$7,586
Total non interest bearing cash at beginning of year2019-12-31$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$813,140
Value of net assets at end of year (total assets less liabilities)2019-12-31$4,204,570
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$0
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$3,831,854
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$0
Interest on participant loans2019-12-31$5,716
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$403,931
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$258,065
Employer contributions (assets) at end of year2019-12-31$258,065
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$174,600
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
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 name2019-12-31MCCLINTOCK ACCOUNTANCY CORPORATION
Accountancy firm EIN2019-12-31942617724

Form 5500 Responses for MARTIS CAMP CLUB 401(K) PLAN

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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number138740
Policy instance 1
Insurance contract or identification number138740
Number of Individuals Covered94
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,748
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2748
Additional information about fees paid to insurance brokerTPA COMP
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number138740
Policy instance 1
Insurance contract or identification number138740
Number of Individuals Covered87
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,766
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2766
Additional information about fees paid to insurance brokerTPA COMP
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number138740
Policy instance 1
Insurance contract or identification number138740
Number of Individuals Covered81
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,855
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2505
Additional information about fees paid to insurance brokerTPA COMP
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number138740
Policy instance 1
Insurance contract or identification number138740
Number of Individuals Covered74
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 $14,207
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees12557
Additional information about fees paid to insurance brokerTPA COMP
Insurance broker organization code?5

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