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MODERN DENTAL SERVICES 401(K) PLAN 401k Plan overview

Plan NameMODERN DENTAL SERVICES 401(K) PLAN
Plan identification number 001

MODERN DENTAL SERVICES 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.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

APEX DENTAL PARTNERS has sponsored the creation of one or more 401k plans.

Company Name:APEX DENTAL PARTNERS
Employer identification number (EIN):471208403
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MODERN DENTAL SERVICES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01JEFFREY BRUSH2019-08-16
0012017-01-01JEFFREY BRUSH2018-07-19
0012016-01-01JEFFREY BRUSH2017-09-28

Plan Statistics for MODERN DENTAL SERVICES 401(K) PLAN

401k plan membership statisitcs for MODERN DENTAL SERVICES 401(K) PLAN

Measure Date Value
2022: MODERN DENTAL SERVICES 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01529
Total number of active participants reported on line 7a of the Form 55002022-01-01581
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0121
Total of all active and inactive participants2022-01-01602
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01602
Number of participants with account balances2022-01-01312
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: MODERN DENTAL SERVICES 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01322
Total number of active participants reported on line 7a of the Form 55002021-01-01481
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0136
Total of all active and inactive participants2021-01-01517
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01517
Number of participants with account balances2021-01-01263
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: MODERN DENTAL SERVICES 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01223
Total number of active participants reported on line 7a of the Form 55002020-01-01294
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 participants2020-01-01308
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01308
Number of participants with account balances2020-01-01162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: MODERN DENTAL SERVICES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01147
Total number of active participants reported on line 7a of the Form 55002019-01-01204
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0111
Total of all active and inactive participants2019-01-01215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01215
Number of participants with account balances2019-01-01102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010

Financial Data on MODERN DENTAL SERVICES 401(K) PLAN

Measure Date Value
2022 : MODERN DENTAL SERVICES 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$2,995,207
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$618,784
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$536,828
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$4,431,547
Value of total assets at end of year2022-12-31$9,301,365
Value of total assets at beginning of year2022-12-31$6,924,942
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$81,956
Total interest from all sources2022-12-31$14
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$2,250
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$1,643,102
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$1,175
Assets. Other investments not covered elsewhere at end of year2022-12-31$1,048,365
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$83,681
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$2,041,845
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$68,212
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$2,376,423
Value of net assets at end of year (total assets less liabilities)2022-12-31$9,301,365
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$6,924,942
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$8,252,954
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$6,771,874
Interest on participant loans2022-12-31$14
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$46
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Net investment gain/loss from pooled separate accounts2022-12-31$-1,436,354
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$746,600
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$536,828
Contract administrator fees2022-12-31$79,706
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 name2022-12-31SEIDEL SCHROEDER
Accountancy firm EIN2022-12-31742052353
2021 : MODERN DENTAL SERVICES 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$3,602,152
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$979,705
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$894,481
Value of total corrective distributions2021-12-31$17,609
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,966,222
Value of total assets at end of year2021-12-31$6,924,942
Value of total assets at beginning of year2021-12-31$4,302,495
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$67,615
Total interest from all sources2021-12-31$108
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$2,550
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$1,308,581
Participant contributions at end of year2021-12-31$1,175
Participant contributions at beginning of year2021-12-31$2,021
Assets. Other investments not covered elsewhere at end of year2021-12-31$83,681
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$56,308
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$1,094,327
Total non interest bearing cash at end of year2021-12-31$68,212
Total non interest bearing cash at beginning of year2021-12-31$30,625
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$2,622,447
Value of net assets at end of year (total assets less liabilities)2021-12-31$6,924,942
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$4,302,495
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$6,771,874
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$4,213,541
Interest on participant loans2021-12-31$108
Net investment gain or loss from common/collective trusts2021-12-31$635,822
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$563,314
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$894,481
Contract administrator fees2021-12-31$65,065
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 name2021-12-31SEIDEL SCHROEDER
Accountancy firm EIN2021-12-31742052353
2020 : MODERN DENTAL SERVICES 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,979,687
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$175,544
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$142,069
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,351,033
Value of total assets at end of year2020-12-31$4,302,495
Value of total assets at beginning of year2020-12-31$2,498,352
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$33,475
Total interest from all sources2020-12-31$195
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
Administrative expenses professional fees incurred2020-12-31$825
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$249,836
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$699,612
Participant contributions at end of year2020-12-31$2,021
Participant contributions at beginning of year2020-12-31$3,284
Assets. Other investments not covered elsewhere at end of year2020-12-31$56,308
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$12,430
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$303,804
Total non interest bearing cash at end of year2020-12-31$30,625
Total non interest bearing cash at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,804,143
Value of net assets at end of year (total assets less liabilities)2020-12-31$4,302,495
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$2,498,352
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$4,213,541
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$2,482,638
Interest on participant loans2020-12-31$195
Net investment gain/loss from pooled separate accounts2020-12-31$628,459
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$347,617
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$142,069
Contract administrator fees2020-12-31$32,650
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 name2020-12-31SEIDEL SCHROEDER
Accountancy firm EIN2020-12-31742052353
2019 : MODERN DENTAL SERVICES 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,300,812
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$67,242
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$46,083
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$957,241
Value of total assets at end of year2019-12-31$2,498,352
Value of total assets at beginning of year2019-12-31$1,264,782
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$21,159
Total interest from all sources2019-12-31$201
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$450
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$127,000
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$515,381
Participant contributions at end of year2019-12-31$3,284
Participant contributions at beginning of year2019-12-31$0
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$13,668
Assets. Other investments not covered elsewhere at end of year2019-12-31$12,430
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$10,573
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$170,935
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$1,233,570
Value of net assets at end of year (total assets less liabilities)2019-12-31$2,498,352
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,264,782
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$2,482,638
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$1,231,233
Interest on participant loans2019-12-31$201
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,840
Net investment gain/loss from pooled separate accounts2019-12-31$343,370
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 contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$270,925
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$7,468
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$46,083
Contract administrator fees2019-12-31$20,709
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 name2019-12-31SEIDEL SCHROEDER
Accountancy firm EIN2019-12-31742052353

Form 5500 Responses for MODERN DENTAL SERVICES 401(K) PLAN

2022: MODERN DENTAL SERVICES 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: MODERN DENTAL SERVICES 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: MODERN DENTAL SERVICES 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: MODERN DENTAL SERVICES 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 number121988
Policy instance 1
Insurance contract or identification number121988
Number of Individuals Covered312
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $27,353
Total amount of fees paid to insurance companyUSD $4,183
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
Commission paid to Insurance BrokerUSD $27,353
Insurance broker organization code?3
Amount paid for insurance broker fees4183
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121988
Policy instance 1
Insurance contract or identification number121988
Number of Individuals Covered263
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $23,208
Total amount of fees paid to insurance companyUSD $2,906
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
Commission paid to Insurance BrokerUSD $23,208
Insurance broker organization code?3
Amount paid for insurance broker fees2906
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121988
Policy instance 1
Insurance contract or identification number121988
Number of Individuals Covered162
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $11,537
Total amount of fees paid to insurance companyUSD $1,446
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
Commission paid to Insurance BrokerUSD $11,537
Insurance broker organization code?3
Amount paid for insurance broker fees1446
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121988
Policy instance 1
Insurance contract or identification number121988
Number of Individuals Covered102
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $7,254
Total amount of fees paid to insurance companyUSD $0
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
Commission paid to Insurance BrokerUSD $7,254
Insurance broker organization code?3

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