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SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 401k Plan overview

Plan NameSOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN
Plan identification number 002

SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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

SOMERSET COMMUNITY SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:SOMERSET COMMUNITY SERVICES, INC.
Employer identification number (EIN):520907036
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01DANIELLE BOZMAN2023-10-16
0022021-01-01DANIELLE BOZMAN2022-10-17
0022020-01-01DANIELLE BOZMAN2021-10-13 DANIELLE BOZMAN2021-10-13
0022020-01-01DANIELLE BOZMAN2022-03-28
0022019-01-01DANIELLE BOZMAN2020-10-15 DANIELLE BOZMAN2020-10-15
0022018-01-01DANIELLE BOZMAN2019-10-14 DANIELLE BOZMAN2019-10-14
0022017-01-01
0022016-01-01

Plan Statistics for SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN

401k plan membership statisitcs for SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN

Measure Date Value
2022: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01431
Total number of active participants reported on line 7a of the Form 55002022-01-01439
Number of retired or separated participants receiving benefits2022-01-015
Number of other retired or separated participants entitled to future benefits2022-01-0128
Total of all active and inactive participants2022-01-01472
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01472
Number of participants with account balances2022-01-01180
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-015
2021: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01456
Total number of active participants reported on line 7a of the Form 55002021-01-01455
Number of retired or separated participants receiving benefits2021-01-013
Number of other retired or separated participants entitled to future benefits2021-01-0118
Total of all active and inactive participants2021-01-01476
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01476
Number of participants with account balances2021-01-01158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-013
2020: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01470
Total number of active participants reported on line 7a of the Form 55002020-01-01475
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 participants2020-01-01489
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01489
Number of participants with account balances2020-01-01156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-014
2019: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01381
Total number of active participants reported on line 7a of the Form 55002019-01-01451
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0118
Total of all active and inactive participants2019-01-01469
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01469
Number of participants with account balances2019-01-01165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-018
2018: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01454
Total number of active participants reported on line 7a of the Form 55002018-01-01339
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0118
Total of all active and inactive participants2018-01-01357
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01357
Number of participants with account balances2018-01-01134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0118
2017: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01382
Total number of active participants reported on line 7a of the Form 55002017-01-01442
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0112
Total of all active and inactive participants2017-01-01454
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01454
Number of participants with account balances2017-01-01128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-017
2016: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01360
Total number of active participants reported on line 7a of the Form 55002016-01-01370
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-013
Total of all active and inactive participants2016-01-01373
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01373
Number of participants with account balances2016-01-01104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-015

Financial Data on SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN

Measure Date Value
2022 : SOMERSET COMMUNITY SERVICES, INC. 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$2,542
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$94,954
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$496,593
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$455,085
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$525,576
Value of total assets at end of year2022-12-31$2,395,686
Value of total assets at beginning of year2022-12-31$2,794,783
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$41,508
Total interest from all sources2022-12-31$7,797
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$13,009
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$350,000
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$288,438
Participant contributions at end of year2022-12-31$174,670
Participant contributions at beginning of year2022-12-31$147,511
Participant contributions at end of year2022-12-31$22,897
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$4,649
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$2,542
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$24,693
Total non interest bearing cash at beginning of year2022-12-31$20,628
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-401,639
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,393,144
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$2,794,783
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 pooled separate accounts at end of year2022-12-31$2,154,897
Value of interest in pooled separate accounts at beginning of year2022-12-31$2,626,644
Interest on participant loans2022-12-31$7,797
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-438,419
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$232,489
Employer contributions (assets) at end of year2022-12-31$18,529
Employer contributions (assets) at beginning of year2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$455,085
Contract administrator fees2022-12-31$28,499
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 name2022-12-31MULLEN,SONDBERG,WIMBISH & STONE,PA
Accountancy firm EIN2022-12-31521197902
2021 : SOMERSET COMMUNITY SERVICES, INC. 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$723,479
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$203,872
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$164,137
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$472,464
Value of total assets at end of year2021-12-31$2,794,783
Value of total assets at beginning of year2021-12-31$2,275,176
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$39,735
Total interest from all sources2021-12-31$6,628
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$30,071
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$350,000
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$252,817
Participant contributions at end of year2021-12-31$147,511
Participant contributions at beginning of year2021-12-31$142,758
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$5,356
Total non interest bearing cash at end of year2021-12-31$20,628
Total non interest bearing cash at beginning of year2021-12-31$13,506
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$519,607
Value of net assets at end of year (total assets less liabilities)2021-12-31$2,794,783
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$2,275,176
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 pooled separate accounts at end of year2021-12-31$2,626,644
Value of interest in pooled separate accounts at beginning of year2021-12-31$2,103,875
Interest on participant loans2021-12-31$6,628
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$244,387
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$214,291
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$15,037
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$164,137
Contract administrator fees2021-12-31$9,664
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 name2021-12-31MULLEN,SONDBERG,WIMBISH & STONE,PA
Accountancy firm EIN2021-12-31521197902
2020 : SOMERSET COMMUNITY SERVICES, INC. 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$683,692
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$121,354
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$88,916
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$419,193
Value of total assets at end of year2020-12-31$2,260,143
Value of total assets at beginning of year2020-12-31$1,697,805
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$32,438
Total interest from all sources2020-12-31$6,771
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$170,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$227,406
Participant contributions at end of year2020-12-31$142,758
Participant contributions at beginning of year2020-12-31$114,174
Administrative expenses (other) incurred2020-12-31$32,438
Total non interest bearing cash at end of year2020-12-31$13,508
Total non interest bearing cash at beginning of year2020-12-31$13,017
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$562,338
Value of net assets at end of year (total assets less liabilities)2020-12-31$2,260,143
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,697,805
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 pooled separate accounts at end of year2020-12-31$2,103,877
Value of interest in pooled separate accounts at beginning of year2020-12-31$1,570,614
Interest on participant loans2020-12-31$6,771
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 contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$191,787
Employer contributions (assets) at end of year2020-12-31$15,037
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$88,916
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 plan2020-12-31Unqualified
Accountancy firm name2020-12-31MULLEN,SONDBERG,WIMBISH & STONE,PA
Accountancy firm EIN2020-12-31521197902
2019 : SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
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 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 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$628,474
Total income from all sources (including contributions)2019-12-31$628,474
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$189,470
Total of all expenses incurred2019-12-31$189,470
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$158,709
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$158,709
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$396,566
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$396,566
Value of total assets at end of year2019-12-31$1,697,805
Value of total assets at end of year2019-12-31$1,697,805
Value of total assets at beginning of year2019-12-31$1,258,801
Value of total assets at beginning of year2019-12-31$1,258,801
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$30,761
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$30,761
Total interest from all sources2019-12-31$5,877
Total interest from all sources2019-12-31$5,877
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
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
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$140,000
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
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$210,497
Contributions received from participants2019-12-31$210,497
Participant contributions at end of year2019-12-31$114,174
Participant contributions at end of year2019-12-31$114,174
Participant contributions at beginning of year2019-12-31$84,039
Participant contributions at beginning of year2019-12-31$84,039
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$8,533
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$8,533
Administrative expenses (other) incurred2019-12-31$30,761
Administrative expenses (other) incurred2019-12-31$30,761
Total non interest bearing cash at end of year2019-12-31$13,017
Total non interest bearing cash at end of year2019-12-31$13,017
Total non interest bearing cash at beginning of year2019-12-31$11,623
Total non interest bearing cash at beginning of year2019-12-31$11,623
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
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$439,004
Value of net income/loss2019-12-31$439,004
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,697,805
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,697,805
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,258,801
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,258,801
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
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 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
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$1,570,614
Value of interest in pooled separate accounts at end of year2019-12-31$1,570,614
Value of interest in pooled separate accounts at beginning of year2019-12-31$1,163,139
Value of interest in pooled separate accounts at beginning of year2019-12-31$1,163,139
Interest on participant loans2019-12-31$5,877
Interest on participant loans2019-12-31$5,877
Net investment gain/loss from pooled separate accounts2019-12-31$226,031
Net investment gain/loss from pooled separate accounts2019-12-31$226,031
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$177,536
Contributions received in cash from employer2019-12-31$177,536
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$158,709
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$158,709
Did the plan have assets held for investment2019-12-31Yes
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
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
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
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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31MULLEN,SONDBERG,WIMBISH & STONE,PA
Accountancy firm name2019-12-31MULLEN,SONDBERG,WIMBISH & STONE,PA
Accountancy firm EIN2019-12-31521197902
Accountancy firm EIN2019-12-31521197902
2018 : SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$341,739
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$171,449
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$145,180
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$392,503
Value of total assets at end of year2018-12-31$1,258,801
Value of total assets at beginning of year2018-12-31$1,088,511
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$26,269
Total interest from all sources2018-12-31$3,789
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$140,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$166,871
Participant contributions at end of year2018-12-31$84,039
Participant contributions at beginning of year2018-12-31$58,209
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$80,562
Administrative expenses (other) incurred2018-12-31$26,269
Total non interest bearing cash at end of year2018-12-31$11,623
Total non interest bearing cash at beginning of year2018-12-31$2,147
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$170,290
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,258,801
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$1,088,511
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in pooled separate accounts at end of year2018-12-31$1,163,139
Value of interest in pooled separate accounts at beginning of year2018-12-31$1,028,155
Interest on participant loans2018-12-31$3,789
Net investment gain/loss from pooled separate accounts2018-12-31$-54,553
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$145,070
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$145,180
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31MULLEN,SONDBERG,WIMBISH & STONE,PA
Accountancy firm EIN2018-12-31521197902
2017 : SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$391,110
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$40,671
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$22,825
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$279,153
Value of total assets at end of year2017-12-31$1,088,511
Value of total assets at beginning of year2017-12-31$738,072
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$17,846
Total interest from all sources2017-12-31$1,850
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$7,139
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$140,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$146,973
Participant contributions at end of year2017-12-31$58,209
Participant contributions at beginning of year2017-12-31$24,219
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$3,139
Total non interest bearing cash at end of year2017-12-31$2,147
Total non interest bearing cash at beginning of year2017-12-31$1,470
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$350,439
Value of net assets at end of year (total assets less liabilities)2017-12-31$1,088,511
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$738,072
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in pooled separate accounts at end of year2017-12-31$1,028,155
Value of interest in pooled separate accounts at beginning of year2017-12-31$712,383
Interest on participant loans2017-12-31$1,850
Net investment gain/loss from pooled separate accounts2017-12-31$110,107
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$129,041
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$22,825
Contract administrator fees2017-12-31$10,707
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31MULLEN,SONDBERG,WIMBISH & STONE,PA
Accountancy firm EIN2017-12-31521197902
2016 : SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$752,523
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$14,451
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$4,913
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$715,128
Value of total assets at end of year2016-12-31$738,072
Value of total assets at beginning of year2016-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$9,538
Total interest from all sources2016-12-31$441
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$3,849
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$140,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$114,683
Participant contributions at end of year2016-12-31$24,219
Participant contributions at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$506,423
Total non interest bearing cash at end of year2016-12-31$1,470
Total non interest bearing cash at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$738,072
Value of net assets at end of year (total assets less liabilities)2016-12-31$738,072
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in pooled separate accounts at end of year2016-12-31$712,383
Value of interest in pooled separate accounts at beginning of year2016-12-31$0
Interest on participant loans2016-12-31$441
Net investment gain/loss from pooled separate accounts2016-12-31$36,954
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$94,022
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$4,913
Contract administrator fees2016-12-31$5,689
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31MULLEN SONBERG WIMBISH & STONE PA
Accountancy firm EIN2016-12-31521197902

Form 5500 Responses for SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN

2022: SOMERSET COMMUNITY SERVICES, INC. 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: SOMERSET COMMUNITY SERVICES, INC. 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: SOMERSET COMMUNITY SERVICES, INC. 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: SOMERSET COMMUNITY SERVICES, INC. 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
2018: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: SOMERSET COMMUNITY SERVICES, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan 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 number120914
Policy instance 1
Insurance contract or identification number120914
Number of Individuals Covered199
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,908
Total amount of fees paid to insurance companyUSD $13,006
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 $1,223
Amount paid for insurance broker fees13006
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number120914
Policy instance 1
Insurance contract or identification number120914
Number of Individuals Covered177
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $7,122
Total amount of fees paid to insurance companyUSD $9,665
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 $1,249
Amount paid for insurance broker fees9665
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number120914
Policy instance 1
Insurance contract or identification number120914
Number of Individuals Covered174
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,179
Total amount of fees paid to insurance companyUSD $8,889
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 $915
Amount paid for insurance broker fees8889
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number120914
Policy instance 1
Insurance contract or identification number120914
Number of Individuals Covered178
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,150
Total amount of fees paid to insurance companyUSD $12,071
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 $765
Amount paid for insurance broker fees12071
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number120914
Policy instance 1
Insurance contract or identification number120914
Number of Individuals Covered148
Insurance policy start date2018-01-14
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,595
Total amount of fees paid to insurance companyUSD $10,675
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 $674
Amount paid for insurance broker fees10675
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number120914
Policy instance 1
Insurance contract or identification number120914
Number of Individuals Covered143
Insurance policy start date2017-01-14
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,927
Total amount of fees paid to insurance companyUSD $7,139
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 $2,234
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSIONS
Insurance broker organization code?3
Insurance broker namePOLLARD & ASSOCIATES, INC.

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