SAMS WELL DRILLING, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2017: SAMS RETIREMENT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 69 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 59 |
| Number of retired or separated participants receiving benefits | 2017-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-11-01 | 7 |
| Total of all active and inactive participants | 2017-11-01 | 66 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-11-01 | 0 |
| Total participants | 2017-11-01 | 66 |
| Number of participants with account balances | 2017-11-01 | 53 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-11-01 | 1 |
| 2016: SAMS RETIREMENT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 77 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 59 |
| Number of retired or separated participants receiving benefits | 2016-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-11-01 | 10 |
| Total of all active and inactive participants | 2016-11-01 | 69 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-11-01 | 0 |
| Total participants | 2016-11-01 | 69 |
| Number of participants with account balances | 2016-11-01 | 57 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-11-01 | 3 |
| 2015: SAMS RETIREMENT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 74 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 72 |
| Number of retired or separated participants receiving benefits | 2015-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-11-01 | 5 |
| Total of all active and inactive participants | 2015-11-01 | 77 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-11-01 | 0 |
| Total participants | 2015-11-01 | 77 |
| Number of participants with account balances | 2015-11-01 | 59 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-11-01 | 2 |
| 2014: SAMS RETIREMENT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 73 |
| Number of retired or separated participants receiving benefits | 2014-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-11-01 | 1 |
| Total of all active and inactive participants | 2014-11-01 | 74 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-11-01 | 0 |
| Total participants | 2014-11-01 | 74 |
| Number of participants with account balances | 2014-11-01 | 34 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-11-01 | 0 |
| 2013: SAMS RETIREMENT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 64 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 70 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 1 |
| Total of all active and inactive participants | 2013-11-01 | 71 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-11-01 | 0 |
| Total participants | 2013-11-01 | 71 |
| Number of participants with account balances | 2013-11-01 | 34 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-11-01 | 0 |
| 2012: SAMS RETIREMENT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 64 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 63 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 1 |
| Total of all active and inactive participants | 2012-11-01 | 64 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-11-01 | 0 |
| Total participants | 2012-11-01 | 64 |
| Number of participants with account balances | 2012-11-01 | 34 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-11-01 | 0 |
| 2011: SAMS RETIREMENT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 63 |
| Number of retired or separated participants receiving benefits | 2011-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-11-01 | 1 |
| Total of all active and inactive participants | 2011-11-01 | 64 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-11-01 | 0 |
| Total participants | 2011-11-01 | 64 |
| Number of participants with account balances | 2011-11-01 | 33 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-11-01 | 0 |
| 2010: SAMS RETIREMENT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 47 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 54 |
| Number of retired or separated participants receiving benefits | 2010-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-11-01 | 1 |
| Total of all active and inactive participants | 2010-11-01 | 55 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-11-01 | 0 |
| Total participants | 2010-11-01 | 55 |
| Number of participants with account balances | 2010-11-01 | 32 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-11-01 | 0 |
| 2009: SAMS RETIREMENT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 44 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 46 |
| Number of retired or separated participants receiving benefits | 2009-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-11-01 | 1 |
| Total of all active and inactive participants | 2009-11-01 | 47 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-11-01 | 0 |
| Total participants | 2009-11-01 | 47 |
| Number of participants with account balances | 2009-11-01 | 31 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-11-01 | 0 |
| Measure | Date | Value |
|---|
| 2018 : SAMS RETIREMENT PLAN 2018 401k financial data |
|---|
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2018-10-31 | $0 |
| 2017 : SAMS RETIREMENT PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-10-31 | $970,741 |
| Expenses. Total of all expenses incurred | 2017-10-31 | $87,126 |
| Benefits paid (including direct rollovers) | 2017-10-31 | $71,069 |
| Total plan assets at end of year | 2017-10-31 | $3,581,476 |
| Total plan assets at beginning of year | 2017-10-31 | $2,697,861 |
| Value of fidelity bond covering the plan | 2017-10-31 | $300,000 |
| Total contributions received or receivable from participants | 2017-10-31 | $261,584 |
| Other income received | 2017-10-31 | $563,075 |
| Net income (gross income less expenses) | 2017-10-31 | $883,615 |
| Net plan assets at end of year (total assets less liabilities) | 2017-10-31 | $3,581,476 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-10-31 | $2,697,861 |
| Total contributions received or receivable from employer(s) | 2017-10-31 | $146,082 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-10-31 | $16,057 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2017-10-31 | $0 |
| 2016 : SAMS RETIREMENT PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-10-31 | $380,830 |
| Expenses. Total of all expenses incurred | 2016-10-31 | $85,700 |
| Benefits paid (including direct rollovers) | 2016-10-31 | $73,275 |
| Total plan assets at end of year | 2016-10-31 | $2,697,861 |
| Total plan assets at beginning of year | 2016-10-31 | $2,402,731 |
| Value of fidelity bond covering the plan | 2016-10-31 | $250,000 |
| Total contributions received or receivable from participants | 2016-10-31 | $201,544 |
| Other income received | 2016-10-31 | $65,549 |
| Net income (gross income less expenses) | 2016-10-31 | $295,130 |
| Net plan assets at end of year (total assets less liabilities) | 2016-10-31 | $2,697,861 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-10-31 | $2,402,731 |
| Total contributions received or receivable from employer(s) | 2016-10-31 | $113,737 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-10-31 | $12,425 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2016-10-31 | $0 |
| 2015 : SAMS RETIREMENT PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-10-31 | $211,765 |
| Expenses. Total of all expenses incurred | 2015-10-31 | $149,946 |
| Benefits paid (including direct rollovers) | 2015-10-31 | $137,779 |
| Total plan assets at end of year | 2015-10-31 | $2,402,731 |
| Total plan assets at beginning of year | 2015-10-31 | $2,340,912 |
| Value of fidelity bond covering the plan | 2015-10-31 | $250,000 |
| Total contributions received or receivable from participants | 2015-10-31 | $113,202 |
| Other income received | 2015-10-31 | $33,089 |
| Net income (gross income less expenses) | 2015-10-31 | $61,819 |
| Net plan assets at end of year (total assets less liabilities) | 2015-10-31 | $2,402,731 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-10-31 | $2,340,912 |
| Total contributions received or receivable from employer(s) | 2015-10-31 | $65,474 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-10-31 | $12,167 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2015-10-31 | $0 |
| 2014 : SAMS RETIREMENT PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-10-31 | $329,230 |
| Expenses. Total of all expenses incurred | 2014-10-31 | $19,596 |
| Benefits paid (including direct rollovers) | 2014-10-31 | $8,532 |
| Total plan assets at end of year | 2014-10-31 | $2,340,912 |
| Total plan assets at beginning of year | 2014-10-31 | $2,031,278 |
| Value of fidelity bond covering the plan | 2014-10-31 | $210,000 |
| Total contributions received or receivable from participants | 2014-10-31 | $103,568 |
| Other income received | 2014-10-31 | $207,447 |
| Net income (gross income less expenses) | 2014-10-31 | $309,634 |
| Net plan assets at end of year (total assets less liabilities) | 2014-10-31 | $2,340,912 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-10-31 | $2,031,278 |
| Total contributions received or receivable from employer(s) | 2014-10-31 | $18,215 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-10-31 | $11,064 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2014-10-31 | $0 |
| 2013 : SAMS RETIREMENT PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-10-31 | $511,848 |
| Expenses. Total of all expenses incurred | 2013-10-31 | $149,313 |
| Benefits paid (including direct rollovers) | 2013-10-31 | $139,816 |
| Total plan assets at end of year | 2013-10-31 | $2,031,278 |
| Total plan assets at beginning of year | 2013-10-31 | $1,668,743 |
| Value of fidelity bond covering the plan | 2013-10-31 | $200,000 |
| Total contributions received or receivable from participants | 2013-10-31 | $99,223 |
| Contributions received from other sources (not participants or employers) | 2013-10-31 | $21,252 |
| Other income received | 2013-10-31 | $375,305 |
| Net income (gross income less expenses) | 2013-10-31 | $362,535 |
| Net plan assets at end of year (total assets less liabilities) | 2013-10-31 | $2,031,278 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-10-31 | $1,668,743 |
| Total contributions received or receivable from employer(s) | 2013-10-31 | $16,068 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-10-31 | $9,497 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2013-10-31 | $0 |
| 2012 : SAMS RETIREMENT PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-10-31 | $307,948 |
| Expenses. Total of all expenses incurred | 2012-10-31 | $10,753 |
| Total plan assets at end of year | 2012-10-31 | $1,668,743 |
| Total plan assets at beginning of year | 2012-10-31 | $1,371,548 |
| Value of fidelity bond covering the plan | 2012-10-31 | $150,000 |
| Total contributions received or receivable from participants | 2012-10-31 | $89,068 |
| Contributions received from other sources (not participants or employers) | 2012-10-31 | $69,872 |
| Other income received | 2012-10-31 | $132,298 |
| Net income (gross income less expenses) | 2012-10-31 | $297,195 |
| Net plan assets at end of year (total assets less liabilities) | 2012-10-31 | $1,668,743 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-10-31 | $1,371,548 |
| Total contributions received or receivable from employer(s) | 2012-10-31 | $16,710 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-10-31 | $10,753 |
| 2011 : SAMS RETIREMENT PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-10-31 | $161,968 |
| Expenses. Total of all expenses incurred | 2011-10-31 | $12,231 |
| Total plan assets at end of year | 2011-10-31 | $1,371,548 |
| Total plan assets at beginning of year | 2011-10-31 | $1,221,811 |
| Value of fidelity bond covering the plan | 2011-10-31 | $150,000 |
| Total contributions received or receivable from participants | 2011-10-31 | $84,772 |
| Other income received | 2011-10-31 | $42,196 |
| Net income (gross income less expenses) | 2011-10-31 | $149,737 |
| Net plan assets at end of year (total assets less liabilities) | 2011-10-31 | $1,371,548 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-10-31 | $1,221,811 |
| Total contributions received or receivable from employer(s) | 2011-10-31 | $35,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-10-31 | $12,231 |
| 2010 : SAMS RETIREMENT PLAN 2010 401k financial data |
|---|
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2010-10-31 | $0 |
| 2017: SAMS RETIREMENT PLAN 2017 form 5500 responses |
|---|
| 2017-11-01 | Type of plan entity | Mulitple employer plan |
| 2017-11-01 | Submission has been amended | No |
| 2017-11-01 | This submission is the final filing | No |
| 2017-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-11-01 | Plan is a collectively bargained plan | No |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan funding arrangement – Trust | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement - Trust | Yes |
| 2016: SAMS RETIREMENT PLAN 2016 form 5500 responses |
|---|
| 2016-11-01 | Type of plan entity | Mulitple employer plan |
| 2016-11-01 | Submission has been amended | No |
| 2016-11-01 | This submission is the final filing | No |
| 2016-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-11-01 | Plan is a collectively bargained plan | No |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan funding arrangement – Trust | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement - Trust | Yes |
| 2015: SAMS RETIREMENT PLAN 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Mulitple employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan funding arrangement – Trust | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement - Trust | Yes |
| 2014: SAMS RETIREMENT PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Mulitple employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – Trust | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement - Trust | Yes |
| 2013: SAMS RETIREMENT PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Mulitple employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan funding arrangement – Trust | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement - Trust | Yes |
| 2012: SAMS RETIREMENT PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Mulitple employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan funding arrangement – Trust | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement - Trust | Yes |
| 2011: SAMS RETIREMENT PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Submission has been amended | No |
| 2011-11-01 | This submission is the final filing | No |
| 2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-11-01 | Plan is a collectively bargained plan | No |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan funding arrangement – Trust | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement - Trust | Yes |
| 2010: SAMS RETIREMENT PLAN 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Submission has been amended | No |
| 2010-11-01 | This submission is the final filing | No |
| 2010-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-11-01 | Plan is a collectively bargained plan | No |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan funding arrangement – Trust | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-11-01 | Plan benefit arrangement - Trust | Yes |
| 2009: SAMS RETIREMENT PLAN 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Submission has been amended | No |
| 2009-11-01 | This submission is the final filing | No |
| 2009-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-11-01 | Plan is a collectively bargained plan | No |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan funding arrangement – Trust | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement - Trust | Yes |
| 2008: SAMS RETIREMENT PLAN 2008 form 5500 responses |
|---|
| 2008-11-01 | Type of plan entity | Single employer plan |
| 2008-11-01 | Submission has been amended | No |
| 2008-11-01 | This submission is the final filing | No |
| 2008-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-11-01 | Plan is a collectively bargained plan | No |
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 21050 |
| Policy instance | 1 |
| Insurance contract or identification number | 21050 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $18,431 | | Total amount of fees paid to insurance company | USD $2,351 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 number | 21050 |
| Policy instance | 1 |
| Insurance contract or identification number | 21050 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $11,019 | | Total amount of fees paid to insurance company | USD $1,467 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,019 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 1467 | | Additional information about fees paid to insurance broker | TPA SERVICES | | Insurance broker name | PPG RETIREMENT PLAN SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 21050 |
| Policy instance | 1 |
| Insurance contract or identification number | 21050 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $10,992 | | Total amount of fees paid to insurance company | USD $1,395 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,992 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 1395 | | Additional information about fees paid to insurance broker | TPA SERVICES | | Insurance broker name | PPG RETIREMENT PLAN SERVICES |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 21050 |
| Policy instance | 1 |
| Insurance contract or identification number | 21050 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $11,818 | | Total amount of fees paid to insurance company | USD $1,149 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,124 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 1149 | | Additional information about fees paid to insurance broker | TPA SERVICES | | Insurance broker name | PPG RETIREMENT PLAN SERVICES |
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| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 21050 |
| Policy instance | 1 |
| Insurance contract or identification number | 21050 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $9,264 | | Total amount of fees paid to insurance company | USD $988 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,264 | | Insurance broker organization code? | 7 | | Amount paid for insurance broker fees | 988 | | Additional information about fees paid to insurance broker | TPA SERVICES | | Insurance broker name | PPG RETIREMENT PLAN SERVICES |
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| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 21050 |
| Policy instance | 1 |
| Insurance contract or identification number | 21050 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $7,347 | | Total amount of fees paid to insurance company | USD $819 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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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| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 21050 |
| Policy instance | 1 |
| Insurance contract or identification number | 21050 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $6,087 | | Total amount of fees paid to insurance company | USD $652 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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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