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LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN 401k Plan overview

Plan NameLIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN
Plan identification number 002

LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 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.
  • 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

LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE has sponsored the creation of one or more 401k plans.

Company Name:LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE
Employer identification number (EIN):363191281
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01
0022021-01-01
0022020-01-01
0022019-01-01
0022018-01-01
0022017-01-01

Plan Statistics for LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN

401k plan membership statisitcs for LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN

Measure Date Value
2022: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01179
Total number of active participants reported on line 7a of the Form 55002022-01-01145
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0134
Total of all active and inactive participants2022-01-01179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01179
Number of participants with account balances2022-01-01155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01171
Total number of active participants reported on line 7a of the Form 55002021-01-01144
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0128
Total of all active and inactive participants2021-01-01172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01172
Number of participants with account balances2021-01-01144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01150
Total number of active participants reported on line 7a of the Form 55002020-01-01148
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0114
Total of all active and inactive participants2020-01-01162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01162
Number of participants with account balances2020-01-01131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01127
Total number of active participants reported on line 7a of the Form 55002019-01-01111
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 participants2019-01-01127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01127
Number of participants with account balances2019-01-01107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010

Financial Data on LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN

Measure Date Value
2022 : LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 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$0
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$316,389
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$294,948
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$251,560
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,439,847
Value of total assets at end of year2022-12-31$6,812,700
Value of total assets at beginning of year2022-12-31$6,791,259
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$43,388
Total interest from all sources2022-12-31$1,560
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
Administrative expenses professional fees incurred2022-12-31$275
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$801,401
Participant contributions at end of year2022-12-31$41,131
Participant contributions at beginning of year2022-12-31$18,627
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$273,497
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$21,441
Value of net assets at end of year (total assets less liabilities)2022-12-31$6,812,700
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$6,791,259
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$17,336
Value of interest in pooled separate accounts at end of year2022-12-31$6,771,569
Value of interest in pooled separate accounts at beginning of year2022-12-31$6,772,632
Interest on participant loans2022-12-31$1,560
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,125,018
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$364,949
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$251,560
Contract administrator fees2022-12-31$25,777
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 name2022-12-31JMM CPA
Accountancy firm EIN2022-12-31472940358
2021 : LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 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$2,078,188
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$421,141
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$381,372
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,170,541
Value of total assets at end of year2021-12-31$6,791,259
Value of total assets at beginning of year2021-12-31$5,134,212
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$39,769
Total interest from all sources2021-12-31$925
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$714,774
Participant contributions at end of year2021-12-31$18,627
Participant contributions at beginning of year2021-12-31$18,919
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$110,606
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$1,657,047
Value of net assets at end of year (total assets less liabilities)2021-12-31$6,791,259
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$5,134,212
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$16,045
Value of interest in pooled separate accounts at end of year2021-12-31$6,772,632
Value of interest in pooled separate accounts at beginning of year2021-12-31$5,115,293
Interest on participant loans2021-12-31$925
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$906,722
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$345,161
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$381,372
Contract administrator fees2021-12-31$23,724
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 name2021-12-31JMM CPA
Accountancy firm EIN2021-12-31472940358
2020 : LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 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$4,034
Total income from all sources (including contributions)2020-12-31$1,744,152
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$392,789
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$364,937
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,029,464
Value of total assets at end of year2020-12-31$5,134,212
Value of total assets at beginning of year2020-12-31$3,786,883
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$27,852
Total interest from all sources2020-12-31$572
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$605,137
Participant contributions at end of year2020-12-31$18,919
Participant contributions at beginning of year2020-12-31$2,216
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$114,843
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$4,034
Other income not declared elsewhere2020-12-31$37
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$1,351,363
Value of net assets at end of year (total assets less liabilities)2020-12-31$5,134,212
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$3,782,849
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$11,207
Value of interest in pooled separate accounts at end of year2020-12-31$5,115,293
Value of interest in pooled separate accounts at beginning of year2020-12-31$3,784,667
Interest on participant loans2020-12-31$572
Net investment gain/loss from pooled separate accounts2020-12-31$714,079
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 contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$309,484
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$364,937
Contract administrator fees2020-12-31$16,645
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 name2020-12-31JMM CPA
Accountancy firm EIN2020-12-31472940358
2019 : LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$4,034
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$1,450,663
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$207,711
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$185,957
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$824,087
Value of total assets at end of year2019-12-31$3,786,883
Value of total assets at beginning of year2019-12-31$2,539,897
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$21,754
Total interest from all sources2019-12-31$307
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$300
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
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$513,645
Participant contributions at end of year2019-12-31$2,216
Participant contributions at beginning of year2019-12-31$6,863
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$66,651
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$4,034
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$180
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$1,242,952
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,782,849
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$2,539,897
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$8,547
Value of interest in pooled separate accounts at end of year2019-12-31$3,784,667
Value of interest in pooled separate accounts at beginning of year2019-12-31$2,533,034
Interest on participant loans2019-12-31$307
Net investment gain/loss from pooled separate accounts2019-12-31$626,089
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$243,791
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$185,957
Contract administrator fees2019-12-31$12,907
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 name2019-12-31WERMER ROGERS DORAN & RUZON LLC
Accountancy firm EIN2019-12-31362416552

Form 5500 Responses for LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN

2022: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 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: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 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: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 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: LIGHTWAYS HOSPICE AND SERIOUS ILLNESS CARE 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – 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 number127252
Policy instance 1
Insurance contract or identification number127252
Number of Individuals Covered164
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 $3,504
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 fees3504
Additional information about fees paid to insurance brokerTPA FEES AND COMPENSATION
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number127252
Policy instance 1
Insurance contract or identification number127252
Number of Individuals Covered155
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 $2,946
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 fees2946
Additional information about fees paid to insurance brokerTPA FEES AND COMPENSATION
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number127252
Policy instance 1
Insurance contract or identification number127252
Number of Individuals Covered142
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 $2,028
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 fees2028
Additional information about fees paid to insurance brokerTPA FEES AND COMPENSATION
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number127252
Policy instance 1
Insurance contract or identification number127252
Number of Individuals Covered126
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 $481
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 fees300
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5

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