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LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan NameLEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST
Plan identification number 001

LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

LEVIN FAMILY DENTAL PROFESSIONAL LLC has sponsored the creation of one or more 401k plans.

Company Name:LEVIN FAMILY DENTAL PROFESSIONAL LLC
Employer identification number (EIN):455435065
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012022-01-01
0012021-01-01
0012021-01-01
0012020-01-01SARAH MONTGOMERY2021-06-08
0012019-01-01
0012018-01-01BRETT R. LEVIN, DDS2019-04-02
0012018-01-01BRETT R. LEVIN, DDS2019-03-30
0012017-01-01BRETT R. LEVIN, DDS2018-04-08
0012016-01-01BRETT R. LEVIN, DDS2017-06-08
0012015-01-01BRETT R. LEVIN, DDS2016-02-12
0012014-01-01BRETT R. LEVIN, DDS2015-04-15
0012013-01-01BRETT R. LEVIN, DDS
0012012-01-01BRETT R. LEVIN, DDS

Plan Statistics for LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST

Measure Date Value
2022: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-01235
Total number of active participants reported on line 7a of the Form 55002022-01-01265
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-0140
Total of all active and inactive participants2022-01-01306
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01306
Number of participants with account balances2022-01-011
2021: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01165
Total number of active participants reported on line 7a of the Form 55002021-01-01181
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0126
Total of all active and inactive participants2021-01-01207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01207
Number of participants with account balances2021-01-01130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2013: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0110
Total number of active participants reported on line 7a of the Form 55002013-01-018
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-018
Number of participants with account balances2013-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-019
Total number of active participants reported on line 7a of the Form 55002012-01-017
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0110
Number of participants with account balances2012-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST

Measure Date Value
2022 : LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 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$737,567
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$314,875
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$262,179
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,353,514
Value of total assets at end of year2022-12-31$10,090,970
Value of total assets at beginning of year2022-12-31$9,668,278
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$52,696
Total interest from all sources2022-12-31$645
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$4,578
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 period2022-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,052,440
Participant contributions at end of year2022-12-31$1,361
Participant contributions at beginning of year2022-12-31$7,696
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$722,719
Assets. Loans (other than to participants) at end of year2022-12-31$30,279
Assets. Loans (other than to participants) at beginning of year2022-12-31$673
Administrative expenses (other) incurred2022-12-31$4,604
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$422,692
Value of net assets at end of year (total assets less liabilities)2022-12-31$10,090,970
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$9,668,278
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$43,514
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$9,798,737
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$9,534,324
Interest on participant loans2022-12-31$645
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$260,301
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$123,557
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,616,592
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 contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$578,355
Employer contributions (assets) at end of year2022-12-31$292
Employer contributions (assets) at beginning of year2022-12-31$2,028
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$262,179
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31Yes
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 name2022-12-31PLANT MORAN
Accountancy firm EIN2022-12-31381357951
2021 : LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 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$6,773,043
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$205,625
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$161,608
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$5,687,807
Value of total assets at end of year2021-12-31$9,665,428
Value of total assets at beginning of year2021-12-31$3,098,010
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$44,017
Total interest from all sources2021-12-31$47
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
Administrative expenses professional fees incurred2021-12-31$2,712
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 period2021-12-31Yes
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$722,775
Participant contributions at end of year2021-12-31$6,281
Participant contributions at beginning of year2021-12-31$29,105
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$4,630,050
Assets. Loans (other than to participants) at end of year2021-12-31$673
Assets. Loans (other than to participants) at beginning of year2021-12-31$8,441
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$990
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$6,567,418
Value of net assets at end of year (total assets less liabilities)2021-12-31$9,665,428
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$3,098,010
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$41,305
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$9,534,324
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$3,045,778
Interest on participant loans2021-12-31$47
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$123,557
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,085,189
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 contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$334,982
Employer contributions (assets) at end of year2021-12-31$593
Employer contributions (assets) at beginning of year2021-12-31$13,696
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$161,608
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31Yes
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 name2021-12-31PLANT MORAN
Accountancy firm EIN2021-12-31381357951
2013 : LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 2013 401k financial data
Total income from all sources2013-12-31$206,400
Expenses. Total of all expenses incurred2013-12-31$390,691
Benefits paid (including direct rollovers)2013-12-31$387,419
Total plan assets at end of year2013-12-31$786,053
Total plan assets at beginning of year2013-12-31$970,344
Value of fidelity bond covering the plan2013-12-31$100,000
Total contributions received or receivable from participants2013-12-31$43,843
Other income received2013-12-31$115,498
Net income (gross income less expenses)2013-12-31$-184,291
Net plan assets at end of year (total assets less liabilities)2013-12-31$786,053
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$970,344
Assets. Value of assets in partnership/joint-venture interests2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$47,059
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$3,272
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 2012 401k financial data
Total income from all sources2012-12-31$193,503
Expenses. Total of all expenses incurred2012-12-31$6,299
Benefits paid (including direct rollovers)2012-12-31$2,062
Total plan assets at end of year2012-12-31$970,344
Total plan assets at beginning of year2012-12-31$783,140
Value of fidelity bond covering the plan2012-12-31$100,000
Total contributions received or receivable from participants2012-12-31$40,388
Contributions received from other sources (not participants or employers)2012-12-31$6,246
Other income received2012-12-31$101,467
Net income (gross income less expenses)2012-12-31$187,204
Net plan assets at end of year (total assets less liabilities)2012-12-31$970,344
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$783,140
Assets. Value of assets in partnership/joint-venture interests2012-12-31$21,516
Total contributions received or receivable from employer(s)2012-12-31$45,402
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$4,237
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0

Form 5500 Responses for LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST

2022: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 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 - TrustYes
2021: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 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 - TrustYes
2013: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 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 – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: LEVIN FAMILY DENTAL EMPLOYEE SAVINGS PROFIT SHARING PLAN & TRUST 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 – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number513882-01
Policy instance 1
Insurance contract or identification number513882-01
Number of Individuals Covered44
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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?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 number98114
Policy instance 1
Insurance contract or identification number98114
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-06-14
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $12,353
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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees12353
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker organization code?5
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number513882-01
Policy instance 2
Insurance contract or identification number513882-01
Number of Individuals Covered29
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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?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 number98114
Policy instance 1
Insurance contract or identification number98114
Number of Individuals Covered8
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,305
Total amount of fees paid to insurance companyUSD $549
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?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
Commission paid to Insurance BrokerUSD $4,305
Insurance broker organization code?3
Amount paid for insurance broker fees549
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker nameTPA SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number98114
Policy instance 1
Insurance contract or identification number98114
Number of Individuals Covered9
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,059
Total amount of fees paid to insurance companyUSD $518
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?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
Commission paid to Insurance BrokerUSD $5,059
Insurance broker organization code?3
Amount paid for insurance broker fees518
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker nameTPA SERVICES, INC.

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