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WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 401k Plan overview

Plan NameWESTERN DENTAL SERVICES, INC. 401(K) PLAN B
Plan identification number 002

WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 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.
  • 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.
  • Plan sponsor(s) received services of leased employees, as defined in Code section 414(n), during the plan year.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

WESTERN DENTAL SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:WESTERN DENTAL SERVICES, INC.
Employer identification number (EIN):330065869
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTERN DENTAL SERVICES, INC. 401(K) PLAN B

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022017-01-01KEVIN SIMES
0022016-01-01SHARON CLARK
0022015-01-01
0022014-01-01DEBBIE GOLANKA
0022013-01-01BRADLEY ROGERS
0022012-01-01DAVID JOE
0022011-01-01DAVID JOE
0022010-01-01DAVID JOE
0022009-01-01DAVID JOE

Plan Statistics for WESTERN DENTAL SERVICES, INC. 401(K) PLAN B

401k plan membership statisitcs for WESTERN DENTAL SERVICES, INC. 401(K) PLAN B

Measure Date Value
2017: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2017 401k membership
Total participants, beginning-of-year2017-01-012,979
Total number of active participants reported on line 7a of the Form 55002017-01-010
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 participants2017-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-010
Number of participants with account balances2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2016 401k membership
Total participants, beginning-of-year2016-01-014,535
Total number of active participants reported on line 7a of the Form 55002016-01-012,864
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-01115
Total of all active and inactive participants2016-01-012,979
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-012,979
Number of participants with account balances2016-01-01443
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2015 401k membership
Total participants, beginning-of-year2015-01-013,401
Total number of active participants reported on line 7a of the Form 55002015-01-014,362
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0186
Total of all active and inactive participants2015-01-014,448
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-014,448
Number of participants with account balances2015-01-01334
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2014 401k membership
Total participants, beginning-of-year2014-01-012,793
Total number of active participants reported on line 7a of the Form 55002014-01-012,941
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-01105
Total of all active and inactive participants2014-01-013,046
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-013,046
Number of participants with account balances2014-01-01292
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2013 401k membership
Total participants, beginning-of-year2013-01-012,800
Total number of active participants reported on line 7a of the Form 55002013-01-012,615
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-01108
Total of all active and inactive participants2013-01-012,723
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-012,723
Number of participants with account balances2013-01-01286
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2012 401k membership
Total participants, beginning-of-year2012-01-012,496
Total number of active participants reported on line 7a of the Form 55002012-01-012,627
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-01105
Total of all active and inactive participants2012-01-012,732
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-012,732
Number of participants with account balances2012-01-01286
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2011 401k membership
Total participants, beginning-of-year2011-01-012,405
Total number of active participants reported on line 7a of the Form 55002011-01-012,307
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0198
Total of all active and inactive participants2011-01-012,405
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-012,405
Number of participants with account balances2011-01-01293
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2010 401k membership
Total participants, beginning-of-year2010-01-012,044
Total number of active participants reported on line 7a of the Form 55002010-01-011,837
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0176
Total of all active and inactive participants2010-01-011,913
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-011,913
Number of participants with account balances2010-01-01222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2009 401k membership
Total participants, beginning-of-year2009-01-011,931
Total number of active participants reported on line 7a of the Form 55002009-01-011,848
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0170
Total of all active and inactive participants2009-01-011,918
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-011,918
Number of participants with account balances2009-01-01213
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on WESTERN DENTAL SERVICES, INC. 401(K) PLAN B

Measure Date Value
2017 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2017 401k financial data
Total transfer of assets from this plan2017-01-06$7,201,282
Total income from all sources (including contributions)2017-01-06$128,809
Total of all expenses incurred2017-01-06$7,231
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-01-06$6,479
Value of total assets at end of year2017-01-06$0
Value of total assets at beginning of year2017-01-06$7,079,704
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-01-06$752
Total interest from all sources2017-01-06$206
Total dividends received (eg from common stock, registered investment company shares)2017-01-06$530
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-01-06Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-01-06$0
Total dividends received from registered investment company shares (eg mutual funds)2017-01-06$530
Was this plan covered by a fidelity bond2017-01-06Yes
Value of fidelity bond cover2017-01-06$2,000,000
If this is an individual account plan, was there a blackout period2017-01-06No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-01-06$0
Were there any nonexempt tranactions with any party-in-interest2017-01-06No
Participant contributions at end of year2017-01-06$0
Participant contributions at beginning of year2017-01-06$124,689
Administrative expenses (other) incurred2017-01-06$752
Total non interest bearing cash at beginning of year2017-01-06$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-01-06No
Value of net income/loss2017-01-06$121,578
Value of net assets at end of year (total assets less liabilities)2017-01-06$0
Value of net assets at beginning of year (total assets less liabilities)2017-01-06$7,079,704
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-01-06No
Were any loans by the plan or fixed income obligations due to the plan in default2017-01-06No
Were any leases to which the plan was party in default or uncollectible2017-01-06No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-01-06$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-01-06$6,553,687
Interest on participant loans2017-01-06$113
Interest earned on other investments2017-01-06$93
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-01-06$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-01-06$401,328
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-01-06$128,073
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-01-06No
Was there a failure to transmit to the plan any participant contributions2017-01-06Yes
Has the plan failed to provide any benefit when due under the plan2017-01-06No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-01-06$6,479
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-01-06No
Did the plan have assets held for investment2017-01-06No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-01-06No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-01-06Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-01-06Yes
Opinion of an independent qualified public accountant for this plan2017-01-06Disclaimer
Accountancy firm name2017-01-06SRG, LLP
Accountancy firm EIN2017-01-06954476507
2016 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2016 401k financial data
Total income from all sources (including contributions)2016-12-31$2,580,248
Total of all expenses incurred2016-12-31$678,035
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$628,589
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,980,576
Value of total assets at end of year2016-12-31$7,079,704
Value of total assets at beginning of year2016-12-31$5,177,491
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$49,446
Total interest from all sources2016-12-31$6,945
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$111,328
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$111,328
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$2,000,000
If this is an individual account plan, was there a blackout period2016-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,794,510
Participant contributions at end of year2016-12-31$124,689
Participant contributions at beginning of year2016-12-31$105,505
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$186,066
Administrative expenses (other) incurred2016-12-31$34,891
Total non interest bearing cash at end of year2016-12-31$0
Total non interest bearing cash at beginning of year2016-12-31$5,071,986
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$1,902,213
Value of net assets at end of year (total assets less liabilities)2016-12-31$7,079,704
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$5,177,491
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$13,220
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$6,553,687
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$0
Interest on participant loans2016-12-31$4,591
Interest earned on other investments2016-12-31$2,354
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$401,328
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$481,399
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$628,589
Contract administrator fees2016-12-31$1,335
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31Yes
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31SRG,LLP
Accountancy firm EIN2016-12-31954476507
2015 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets from this plan2015-12-31$586,510
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$1,610,889
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$677,331
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$662,329
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,652,057
Value of total assets at end of year2015-12-31$5,177,491
Value of total assets at beginning of year2015-12-31$4,830,443
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$15,002
Total interest from all sources2015-12-31$3,219
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$14,869
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$2,000,000
If this is an individual account plan, was there a blackout period2015-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$1,097,587
Participant contributions at end of year2015-12-31$105,505
Participant contributions at beginning of year2015-12-31$30,169
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$554,470
Other income not declared elsewhere2015-12-31$9,912
Administrative expenses (other) incurred2015-12-31$133
Total non interest bearing cash at end of year2015-12-31$5,071,986
Total non interest bearing cash at beginning of year2015-12-31$101
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$933,558
Value of net assets at end of year (total assets less liabilities)2015-12-31$5,177,491
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$4,830,443
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$4,651,011
Interest on participant loans2015-12-31$2,279
Interest earned on other investments2015-12-31$940
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$149,162
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-54,299
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31Yes
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$662,329
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31Yes
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31SRG,LLP
Accountancy firm EIN2015-12-31954476507
2014 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total transfer of assets to this plan2014-12-31$54,143
Total transfer of assets from this plan2014-12-31$521,837
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$1,188,703
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$539,356
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$529,491
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$934,111
Value of total assets at end of year2014-12-31$4,830,443
Value of total assets at beginning of year2014-12-31$4,648,790
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$9,865
Total interest from all sources2014-12-31$2,877
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$9,865
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$2,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$906,509
Participant contributions at end of year2014-12-31$30,169
Participant contributions at beginning of year2014-12-31$67,791
Participant contributions at end of year2014-12-31$0
Participant contributions at beginning of year2014-12-31$28,669
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$27,602
Other income not declared elsewhere2014-12-31$3,436
Total non interest bearing cash at end of year2014-12-31$101
Total non interest bearing cash at beginning of year2014-12-31$101
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$649,347
Value of net assets at end of year (total assets less liabilities)2014-12-31$4,830,443
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$4,648,790
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$4,651,011
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$4,435,465
Interest on participant loans2014-12-31$1,715
Interest earned on other investments2014-12-31$1,162
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$149,162
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$116,764
Net investment gain/loss from pooled separate accounts2014-12-31$248,279
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31Yes
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$529,491
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31SRG,LLP
Accountancy firm EIN2014-12-31954476507
2013 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total transfer of assets from this plan2013-12-31$460,522
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$1,459,740
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$696,750
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$684,493
Expenses. Certain deemed distributions of participant loans2013-12-31$2,603
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$738,361
Value of total assets at end of year2013-12-31$4,648,790
Value of total assets at beginning of year2013-12-31$4,346,322
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$9,654
Total interest from all sources2013-12-31$3,253
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$9,654
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$2,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$662,404
Participant contributions at end of year2013-12-31$67,791
Participant contributions at beginning of year2013-12-31$65,169
Participant contributions at end of year2013-12-31$28,669
Participant contributions at beginning of year2013-12-31$20,242
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$75,957
Total non interest bearing cash at end of year2013-12-31$101
Total non interest bearing cash at beginning of year2013-12-31$11
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$762,990
Value of net assets at end of year (total assets less liabilities)2013-12-31$4,648,790
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$4,346,322
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$4,435,465
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$4,163,376
Interest on participant loans2013-12-31$2,173
Interest earned on other investments2013-12-31$1,080
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$116,764
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$97,524
Net investment gain/loss from pooled separate accounts2013-12-31$718,126
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$684,493
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31SRG,LLP
Accountancy firm EIN2013-12-31954476507
2012 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total transfer of assets from this plan2012-12-31$389,968
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$1,463,518
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$317,818
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$308,537
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,029,766
Value of total assets at end of year2012-12-31$4,346,322
Value of total assets at beginning of year2012-12-31$3,590,590
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$9,281
Total interest from all sources2012-12-31$2,873
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$9,281
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$2,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$692,701
Participant contributions at end of year2012-12-31$65,169
Participant contributions at beginning of year2012-12-31$30,798
Participant contributions at end of year2012-12-31$20,242
Participant contributions at beginning of year2012-12-31$45,157
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$337,065
Other income not declared elsewhere2012-12-31$-343
Total non interest bearing cash at end of year2012-12-31$11
Total non interest bearing cash at beginning of year2012-12-31$11
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$1,145,700
Value of net assets at end of year (total assets less liabilities)2012-12-31$4,346,322
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$3,590,590
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$4,163,376
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$3,421,482
Interest on participant loans2012-12-31$1,796
Interest earned on other investments2012-12-31$1,077
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$97,524
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$93,142
Net investment gain/loss from pooled separate accounts2012-12-31$431,222
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$308,537
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31SRG, LLP
Accountancy firm EIN2012-12-31954476507
2011 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total transfer of assets to this plan2011-12-31$6,061
Total transfer of assets from this plan2011-12-31$4,123
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$941,166
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$223,225
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$175,883
Value of total corrective distributions2011-12-31$27,222
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,019,076
Value of total assets at end of year2011-12-31$3,590,590
Value of total assets at beginning of year2011-12-31$2,870,711
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$20,120
Total interest from all sources2011-12-31$2,271
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$20,120
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$2,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$852,022
Participant contributions at end of year2011-12-31$30,798
Participant contributions at beginning of year2011-12-31$21,378
Participant contributions at end of year2011-12-31$45,157
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$167,054
Other income not declared elsewhere2011-12-31$-88
Total non interest bearing cash at end of year2011-12-31$11
Total non interest bearing cash at beginning of year2011-12-31$10
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$717,941
Value of net assets at end of year (total assets less liabilities)2011-12-31$3,590,590
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$2,870,711
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$3,421,482
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$2,779,017
Interest on participant loans2011-12-31$1,125
Interest earned on other investments2011-12-31$1,146
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$93,142
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$70,306
Net investment gain/loss from pooled separate accounts2011-12-31$-80,093
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$175,883
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31SRG, LLP
Accountancy firm EIN2011-12-31954476507
2010 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total transfer of assets to this plan2010-12-31$99,564
Total transfer of assets from this plan2010-12-31$231,062
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$837,637
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$256,274
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$239,479
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$561,751
Value of total assets at end of year2010-12-31$2,870,711
Value of total assets at beginning of year2010-12-31$2,420,846
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$16,795
Total interest from all sources2010-12-31$2,304
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$16,795
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$2,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$561,329
Participant contributions at end of year2010-12-31$21,378
Participant contributions at beginning of year2010-12-31$24,147
Participant contributions at beginning of year2010-12-31$250
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$422
Total non interest bearing cash at end of year2010-12-31$10
Total non interest bearing cash at beginning of year2010-12-31$4,924
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$581,363
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,870,711
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,420,846
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$2,779,017
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$2,343,522
Interest on participant loans2010-12-31$1,102
Interest earned on other investments2010-12-31$1,202
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$70,306
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$48,003
Net investment gain/loss from pooled separate accounts2010-12-31$273,582
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$239,479
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31SOLOMON ROSS GREY & CO
Accountancy firm EIN2010-12-31954476507
2009 : WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for WESTERN DENTAL SERVICES, INC. 401(K) PLAN B

2017: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 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 funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2010: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: WESTERN DENTAL SERVICES, INC. 401(K) PLAN B 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberQK63020
Policy instance 1
Insurance contract or identification numberQK63020
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-06
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberQK63020
Policy instance 2
Insurance contract or identification numberQK63020
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-01-06
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
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 number71365
Policy instance 1
Insurance contract or identification number71365
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,782
Total amount of fees paid to insurance companyUSD $12,002
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
Amount paid for insurance broker fees12002
Additional information about fees paid to insurance brokerADMINISTRATIVE REIMBURSEMENT
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $2,886
Insurance broker nameKPLANS, INC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number71365
Policy instance 1
Insurance contract or identification number71365
Number of Individuals Covered354
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,506
Total amount of fees paid to insurance companyUSD $7,235
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
Amount paid for insurance broker fees7235
Additional information about fees paid to insurance brokerADMINISTRATIVE REIMBURSEMENT
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $4,506
Insurance broker nameKPLANS, INC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number71365
Policy instance 1
Insurance contract or identification number71365
Number of Individuals Covered326
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,186
Total amount of fees paid to insurance companyUSD $33,170
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
Amount paid for insurance broker fees33170
Additional information about fees paid to insurance brokerADMINISTRATIVE REIMBURSEMENT TPA FEES PAID
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $4,186
Insurance broker nameKRAVITZ INVESTMENT SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number71365
Policy instance 1
Insurance contract or identification number71365
Number of Individuals Covered315
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,665
Total amount of fees paid to insurance companyUSD $7,480
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
Amount paid for insurance broker fees7480
Additional information about fees paid to insurance brokerADMINISTRATIVE REIMBURSEMENT TPA FEES PAID
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $3,665
Insurance broker nameKRAVITZ INVESTMENT SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number71365
Policy instance 1
Insurance contract or identification number71365
Number of Individuals Covered324
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,387
Total amount of fees paid to insurance companyUSD $8,435
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number71365
Policy instance 1
Insurance contract or identification number71365
Number of Individuals Covered267
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,984
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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

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