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KLEEN-TEX 401(K) PLAN 401k Plan overview

Plan NameKLEEN-TEX 401(K) PLAN
Plan identification number 001

KLEEN-TEX 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.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

KLEEN-TEX INDUSTRY, INC. has sponsored the creation of one or more 401k plans.

Company Name:KLEEN-TEX INDUSTRY, INC.
Employer identification number (EIN):580979348
NAIC Classification:314000
NAIC Description: Textile Product Mills

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KLEEN-TEX 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01ERISA FIDUCIARY SERVICES2023-04-08
0012021-01-01ERISA FIDUCIARY SERVICES2022-07-08
0012020-01-01CRAIG R HAUN2021-05-24 CRAIG R HAUN2021-05-24
0012019-01-01CRAIG R HAUN2020-06-29 CRAIG R HAUN2020-06-29
0012018-01-01CRAIG R HAUN2019-10-03
0012017-01-01CRAIG R HAUN2018-07-02
0012016-01-01DAWN LOCKABY2017-06-13 DUNCAN ALLEN2017-06-13
0012015-01-01DUNCAN ALLEN2016-06-13 DUNCAN ALLEN2016-06-13
0012014-01-01DUNCAN ALLEN
0012013-01-01LINDA BAILEY
0012012-01-01LINDA BAILEY
0012011-01-01LINDA BAILEY
0012010-01-01LINDA BAILEY LINDA BAILEY2011-10-13
0012009-01-01LINDA BAILEY LINDA BAILEY2010-10-13

Plan Statistics for KLEEN-TEX 401(K) PLAN

401k plan membership statisitcs for KLEEN-TEX 401(K) PLAN

Measure Date Value
2014: KLEEN-TEX 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0113
Total number of active participants reported on line 7a of the Form 55002014-01-016
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-016
Total of all active and inactive participants2014-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0112
Number of participants with account balances2014-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: KLEEN-TEX 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0113
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 benefits2013-01-016
Total of all active and inactive participants2013-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0114
Number of participants with account balances2013-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: KLEEN-TEX 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0116
Total number of active participants reported on line 7a of the Form 55002012-01-018
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-017
Total of all active and inactive participants2012-01-0115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0115
Number of participants with account balances2012-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: KLEEN-TEX 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0117
Total number of active participants reported on line 7a of the Form 55002011-01-017
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0131
Total of all active and inactive participants2011-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0138
Number of participants with account balances2011-01-0138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: KLEEN-TEX 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01173
Total number of active participants reported on line 7a of the Form 55002010-01-017
Number of other retired or separated participants entitled to future benefits2010-01-0143
Total of all active and inactive participants2010-01-0150
Total participants2010-01-0150
Number of participants with account balances2010-01-0150
2009: KLEEN-TEX 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01157
Total number of active participants reported on line 7a of the Form 55002009-01-017
Number of other retired or separated participants entitled to future benefits2009-01-01166
Total of all active and inactive participants2009-01-01173
Total participants2009-01-01173
Number of participants with account balances2009-01-01173

Financial Data on KLEEN-TEX 401(K) PLAN

Measure Date Value
2014 : KLEEN-TEX 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$1,379
Total income from all sources2014-12-31$221,779
Expenses. Total of all expenses incurred2014-12-31$123,232
Benefits paid (including direct rollovers)2014-12-31$123,002
Total plan assets at end of year2014-12-31$2,189,267
Total plan assets at beginning of year2014-12-31$2,089,341
Value of fidelity bond covering the plan2014-12-31$5,000,000
Total contributions received or receivable from participants2014-12-31$63,291
Expenses. Other expenses not covered elsewhere2014-12-31$230
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$127,732
Net income (gross income less expenses)2014-12-31$98,547
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,189,267
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$2,089,341
Assets. Value of participant loans2014-12-31$45,745
Total contributions received or receivable from employer(s)2014-12-31$30,756
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$0
Amount contributed by the employer to the plan for this plan year2014-12-31$0
2013 : KLEEN-TEX 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$412,107
Expenses. Total of all expenses incurred2013-12-31$96,227
Benefits paid (including direct rollovers)2013-12-31$95,828
Total plan assets at end of year2013-12-31$2,089,341
Total plan assets at beginning of year2013-12-31$1,773,461
Value of fidelity bond covering the plan2013-12-31$5,000,000
Total contributions received or receivable from participants2013-12-31$58,556
Expenses. Other expenses not covered elsewhere2013-12-31$399
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$328,512
Net income (gross income less expenses)2013-12-31$315,880
Net plan assets at end of year (total assets less liabilities)2013-12-31$2,089,341
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,773,461
Assets. Value of participant loans2013-12-31$5,774
Total contributions received or receivable from employer(s)2013-12-31$25,039
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Funding deficiency by the employer to the plan for this plan year2013-12-31$0
Minimum employer required contribution for this plan year2013-12-31$0
Amount contributed by the employer to the plan for this plan year2013-12-31$0
2012 : KLEEN-TEX 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$306,528
Expenses. Total of all expenses incurred2012-12-31$976,259
Benefits paid (including direct rollovers)2012-12-31$975,359
Total plan assets at end of year2012-12-31$1,773,461
Total plan assets at beginning of year2012-12-31$2,443,192
Value of fidelity bond covering the plan2012-12-31$5,000,000
Total contributions received or receivable from participants2012-12-31$59,532
Expenses. Other expenses not covered elsewhere2012-12-31$900
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$220,890
Net income (gross income less expenses)2012-12-31$-669,731
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,773,461
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$2,443,192
Assets. Value of participant loans2012-12-31$19,136
Total contributions received or receivable from employer(s)2012-12-31$26,106
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
2011 : KLEEN-TEX 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$-29,876
Expenses. Total of all expenses incurred2011-12-31$234,139
Benefits paid (including direct rollovers)2011-12-31$221,167
Total plan assets at end of year2011-12-31$2,443,192
Total plan assets at beginning of year2011-12-31$2,707,207
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$46,522
Expenses. Other expenses not covered elsewhere2011-12-31$12,972
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-95,577
Net income (gross income less expenses)2011-12-31$-264,015
Net plan assets at end of year (total assets less liabilities)2011-12-31$2,443,192
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$2,707,207
Assets. Value of participant loans2011-12-31$30,932
Total contributions received or receivable from employer(s)2011-12-31$19,179
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Funding deficiency by the employer to the plan for this plan year2011-12-31$0
Minimum employer required contribution for this plan year2011-12-31$0
Amount contributed by the employer to the plan for this plan year2011-12-31$0
2010 : KLEEN-TEX 401(K) PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$12,960
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$132,057
Total income from all sources (including contributions)2010-12-31$344,520
Total of all expenses incurred2010-12-31$291,633
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$276,694
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$70,896
Value of total assets at end of year2010-12-31$2,720,167
Value of total assets at beginning of year2010-12-31$2,786,377
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$14,939
Total interest from all sources2010-12-31$2,576
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$50,496
Participant contributions at end of year2010-12-31$42,415
Participant contributions at beginning of year2010-12-31$46,821
Participant contributions at beginning of year2010-12-31$5,698
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$12,960
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$132,057
Administrative expenses (other) incurred2010-12-31$462
Total non interest bearing cash at end of year2010-12-31$4,594
Total non interest bearing cash at beginning of year2010-12-31$94,823
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$52,887
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,707,207
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,654,320
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in pooled separate accounts at end of year2010-12-31$2,659,555
Value of interest in pooled separate accounts at beginning of year2010-12-31$2,567,465
Interest on participant loans2010-12-31$2,576
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$136
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$136
Net investment gain/loss from pooled separate accounts2010-12-31$271,048
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$20,400
Employer contributions (assets) at end of year2010-12-31$13,467
Employer contributions (assets) at beginning of year2010-12-31$71,434
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$276,694
Contract administrator fees2010-12-31$14,477
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31GAY & JOSEPH, C.P.A., P.C.
Accountancy firm EIN2010-12-31581445724

Form 5500 Responses for KLEEN-TEX 401(K) PLAN

2014: KLEEN-TEX 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: KLEEN-TEX 401(K) PLAN 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
2012: KLEEN-TEX 401(K) PLAN 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
2011: KLEEN-TEX 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: KLEEN-TEX 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: KLEEN-TEX 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-827859
Policy instance 1
Insurance contract or identification numberGA-827859
Number of Individuals Covered12
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,419
Total amount of fees paid to insurance companyUSD $844
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?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 $8,419
Insurance broker organization code?3
Amount paid for insurance broker fees844
Additional information about fees paid to insurance brokerSALES/MARKETING
Insurance broker nameMERRILL LYNCH, PIERCE, FENNER &
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-827859
Policy instance 1
Insurance contract or identification numberGA-827859
Number of Individuals Covered14
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,313
Total amount of fees paid to insurance companyUSD $728
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?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 $7,313
Insurance broker organization code?3
Amount paid for insurance broker fees728
Additional information about fees paid to insurance brokerSALES/MARKETING
Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH I
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-827859
Policy instance 1
Insurance contract or identification numberGA-827859
Number of Individuals Covered8
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $493
Total amount of fees paid to insurance companyUSD $788
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?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
Amount paid for insurance broker fees788
Additional information about fees paid to insurance brokerSALES/MARKETING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $493
Insurance broker nameMERRILL LYNCH LIFE AGENCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-827859
Policy instance 1
Insurance contract or identification numberGA-827859
Number of Individuals Covered38
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $18,692
Total amount of fees paid to insurance companyUSD $0
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?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 number63619
Policy instance 1
Insurance contract or identification number63619
Number of Individuals Covered51
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $10,340
Total amount of fees paid to insurance companyUSD $1,665
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,340
Additional information about fees paid to insurance brokerBROKER COMM
Insurance broker organization code?3
Amount paid for insurance broker fees1665
Insurance broker nameRET PLAN ADMIN LLC

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