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ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN
Plan identification number 002

ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • 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.
  • 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

ACADEMY AT THE FARM, INC. has sponsored the creation of one or more 401k plans.

Company Name:ACADEMY AT THE FARM, INC.
Employer identification number (EIN):593638658
NAIC Classification:611000

Additional information about ACADEMY AT THE FARM, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1999-09-24
Company Identification Number: N99000005704
Legal Registered Office Address: 14217 THIRD STREET

DADE CITY

33523

More information about ACADEMY AT THE FARM, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022021-07-01DINA BARDIN2023-02-28 DINA BARDIN2023-02-28
0022020-07-01RAY POLK2022-03-31 RAY POLK2022-03-31
0022019-07-01RAY POLK2021-04-11 RAY POLK2021-04-11
0022018-07-01D. RAY POLK2020-04-13 D. RAY POLK2020-04-13
0022017-07-01
0022017-07-01
0022016-07-01
0022016-07-01
0022015-07-01RAY POLK2017-04-12
0022015-07-01RAY POLK2017-04-12
0022014-07-01RAY POLK2016-03-24
0022013-07-01RAY POLK2016-02-26 RAY POLK2016-02-26

Plan Statistics for ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN

Measure Date Value
2021: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01123
Total number of active participants reported on line 7a of the Form 55002021-07-01117
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-0118
Total of all active and inactive participants2021-07-01135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-07-010
Total participants2021-07-01135
Number of participants with account balances2021-07-0185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-07-010
2020: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01109
Total number of active participants reported on line 7a of the Form 55002020-07-01105
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-0114
Total of all active and inactive participants2020-07-01119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-07-010
Total participants2020-07-01119
Number of participants with account balances2020-07-0173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-07-010
2019: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01131
Total number of active participants reported on line 7a of the Form 55002019-07-01100
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-0110
Total of all active and inactive participants2019-07-01110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-07-010
Total participants2019-07-01110
Number of participants with account balances2019-07-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-07-010
2018: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01125
Total number of active participants reported on line 7a of the Form 55002018-07-01108
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-0121
Total of all active and inactive participants2018-07-01129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-07-010
Total participants2018-07-01129
Number of participants with account balances2018-07-0182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-07-010

Financial Data on ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-06-30$-521,528
Total unrealized appreciation/depreciation of assets2022-06-30$-521,528
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$3,873
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total income from all sources (including contributions)2022-06-30$-209,459
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$446,589
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$445,540
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$310,323
Value of total assets at end of year2022-06-30$3,143,442
Value of total assets at beginning of year2022-06-30$3,795,617
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$1,049
Total interest from all sources2022-06-30$1,746
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Administrative expenses professional fees incurred2022-06-30$1,049
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$320,000
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$114,301
Participant contributions at end of year2022-06-30$34,914
Participant contributions at beginning of year2022-06-30$46,108
Participant contributions at beginning of year2022-06-30$10,321
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-06-30$3,873
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-656,048
Value of net assets at end of year (total assets less liabilities)2022-06-30$3,139,569
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$3,795,617
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Value of interest in pooled separate accounts at end of year2022-06-30$3,108,528
Value of interest in pooled separate accounts at beginning of year2022-06-30$3,721,872
Interest on participant loans2022-06-30$1,746
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$196,022
Employer contributions (assets) at beginning of year2022-06-30$17,316
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$445,540
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30FRSCPA, PLLC
Accountancy firm EIN2022-06-30592482214
2021 : ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-06-30$787,972
Total unrealized appreciation/depreciation of assets2021-06-30$787,972
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$3
Total income from all sources (including contributions)2021-06-30$1,066,598
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$55,139
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$54,511
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$276,675
Value of total assets at end of year2021-06-30$3,795,616
Value of total assets at beginning of year2021-06-30$2,784,160
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$628
Total interest from all sources2021-06-30$1,951
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Administrative expenses professional fees incurred2021-06-30$628
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$380,000
If this is an individual account plan, was there a blackout period2021-06-30No
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$89,685
Participant contributions at end of year2021-06-30$46,108
Participant contributions at beginning of year2021-06-30$39,893
Participant contributions at end of year2021-06-30$10,320
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-06-30$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$1,011,459
Value of net assets at end of year (total assets less liabilities)2021-06-30$3,795,616
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$2,784,157
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest in pooled separate accounts at end of year2021-06-30$3,721,872
Value of interest in pooled separate accounts at beginning of year2021-06-30$2,744,267
Income. Interest from loans (other than to participants)2021-06-30$1,951
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30No
Was there a failure to transmit to the plan any participant contributions2021-06-30Yes
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$186,990
Employer contributions (assets) at end of year2021-06-30$17,316
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$54,511
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Disclaimer
Accountancy firm name2021-06-30FRSCPA, PLLC
Accountancy firm EIN2021-06-30592482214
2020 : ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-06-30$62,328
Total unrealized appreciation/depreciation of assets2020-06-30$62,328
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$3
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$5
Total income from all sources (including contributions)2020-06-30$333,431
Total loss/gain on sale of assets2020-06-30$0
Total of all expenses incurred2020-06-30$82,853
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$80,262
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$268,269
Value of total assets at end of year2020-06-30$2,784,160
Value of total assets at beginning of year2020-06-30$2,533,584
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$2,591
Total interest from all sources2020-06-30$2,834
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Administrative expenses professional fees incurred2020-06-30$2,591
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$350,000
If this is an individual account plan, was there a blackout period2020-06-30No
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$91,979
Participant contributions at end of year2020-06-30$39,893
Participant contributions at beginning of year2020-06-30$48,283
Income. Received or receivable in cash from other sources (including rollovers)2020-06-30$44
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-06-30$3
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-06-30$5
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$250,578
Value of net assets at end of year (total assets less liabilities)2020-06-30$2,784,157
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$2,533,579
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Value of interest in pooled separate accounts at end of year2020-06-30$2,744,267
Value of interest in pooled separate accounts at beginning of year2020-06-30$2,485,301
Interest on participant loans2020-06-30$2,834
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30No
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$176,246
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$80,262
Did the plan have assets held for investment2020-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30Yes
Opinion of an independent qualified public accountant for this plan2020-06-30Disclaimer
Accountancy firm name2020-06-30FRSCPA, PLLC
Accountancy firm EIN2020-06-30592482214
2019 : ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-06-30$117,573
Total unrealized appreciation/depreciation of assets2019-06-30$117,573
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$5
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total income from all sources (including contributions)2019-06-30$394,279
Total loss/gain on sale of assets2019-06-30$0
Total of all expenses incurred2019-06-30$22,359
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$21,366
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$274,183
Value of total assets at end of year2019-06-30$2,533,584
Value of total assets at beginning of year2019-06-30$2,161,659
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$993
Total interest from all sources2019-06-30$2,523
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Administrative expenses professional fees incurred2019-06-30$993
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$350,000
If this is an individual account plan, was there a blackout period2019-06-30No
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$97,408
Participant contributions at end of year2019-06-30$48,283
Participant contributions at beginning of year2019-06-30$52,614
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-06-30$5
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$371,920
Value of net assets at end of year (total assets less liabilities)2019-06-30$2,533,579
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$2,161,659
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Value of interest in pooled separate accounts at end of year2019-06-30$2,485,301
Value of interest in pooled separate accounts at beginning of year2019-06-30$2,109,045
Interest on participant loans2019-06-30$2,523
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$176,775
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$21,366
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30Yes
Opinion of an independent qualified public accountant for this plan2019-06-30Disclaimer
Accountancy firm name2019-06-30FRSCPA, PLLC
Accountancy firm EIN2019-06-30592482214

Form 5500 Responses for ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN

2021: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: ACADEMY AT THE FARM 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number111244
Policy instance 1
Insurance contract or identification number111244
Number of Individuals Covered85
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $18,019
Total amount of fees paid to insurance companyUSD $2,525
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
Commission paid to Insurance BrokerUSD $18,019
Insurance broker organization code?3
Amount paid for insurance broker fees1825
Additional information about fees paid to insurance brokerTPA COMPENSATION
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number111244
Policy instance 1
Insurance contract or identification number111244
Number of Individuals Covered75
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $16,091
Total amount of fees paid to insurance companyUSD $1,930
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
Commission paid to Insurance BrokerUSD $16,091
Insurance broker organization code?3
Amount paid for insurance broker fees1630
Additional information about fees paid to insurance brokerTPA COMPENSATION
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number111244
Policy instance 1
Insurance contract or identification number111244
Number of Individuals Covered71
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $11,648
Total amount of fees paid to insurance companyUSD $3,097
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
Commission paid to Insurance BrokerUSD $11,648
Insurance broker organization code?3
Amount paid for insurance broker fees1800
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 number111244
Policy instance 1
Insurance contract or identification number111244
Number of Individuals Covered81
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $12,927
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
Amount paid for insurance broker fees11196
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3

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