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FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 401k Plan overview

Plan NameFARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS
Plan identification number 002

FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 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.
  • 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.
  • Stock bonus
  • 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.
  • Leveraged ESOP - An ESOP that acquires employer securities with borrowed money or other debt-financing techniques. A completed Schedule E must be attached to a Form 5500 filed for an ESOP.

401k Sponsoring company profile

FARRIS EVANS INSURANCE AGENCY, INC. has sponsored the creation of one or more 401k plans.

Company Name:FARRIS EVANS INSURANCE AGENCY, INC.
Employer identification number (EIN):620550086
NAIC Classification:524210
NAIC Description:Insurance Agencies and Brokerages

Additional information about FARRIS EVANS INSURANCE AGENCY, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2002-11-18
Company Identification Number: 0800143982
Legal Registered Office Address: 1568 UNION AVE

MEMPHIS
United States of America (USA)
38104

More information about FARRIS EVANS INSURANCE AGENCY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022018-01-01
0022017-01-01J. S. EVANS
0022016-07-01J. S. EVANS
0022015-07-01ANNE SUTTON J. S. EVANS2017-01-10
0022014-07-01J.S.EVANS
0022013-07-01J.S.EVANS
0022012-07-01J.S.EVANS
0022011-07-01J.S.EVANS
0022010-07-01J.S.EVANS
0022009-07-01JEANNIE EVANS

Plan Statistics for FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS

401k plan membership statisitcs for FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS

Measure Date Value
2018: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2018 401k membership
Total participants, beginning-of-year2018-01-0122
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-010
Number of participants with account balances2018-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2017 401k membership
Total participants, beginning-of-year2017-01-0123
Total number of active participants reported on line 7a of the Form 55002017-01-0118
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-014
Total of all active and inactive participants2017-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0122
Number of participants with account balances2017-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2016 401k membership
Total participants, beginning-of-year2016-07-0123
Total number of active participants reported on line 7a of the Form 55002016-07-0118
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-015
Total of all active and inactive participants2016-07-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-0123
Number of participants with account balances2016-07-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-07-010
2015: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2015 401k membership
Total participants, beginning-of-year2015-07-0122
Total number of active participants reported on line 7a of the Form 55002015-07-0121
Number of other retired or separated participants entitled to future benefits2015-07-012
Total of all active and inactive participants2015-07-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-0123
Number of participants with account balances2015-07-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-07-010
2014: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2014 401k membership
Total participants, beginning-of-year2014-07-0123
Total number of active participants reported on line 7a of the Form 55002014-07-0118
Number of retired or separated participants receiving benefits2014-07-014
Total of all active and inactive participants2014-07-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
Total participants2014-07-0122
Number of participants with account balances2014-07-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-010
2013: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2013 401k membership
Total participants, beginning-of-year2013-07-0121
Total number of active participants reported on line 7a of the Form 55002013-07-0120
Number of other retired or separated participants entitled to future benefits2013-07-013
Total of all active and inactive participants2013-07-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-0123
Number of participants with account balances2013-07-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-010
2012: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2012 401k membership
Total participants, beginning-of-year2012-07-0120
Total number of active participants reported on line 7a of the Form 55002012-07-0118
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-013
Total of all active and inactive participants2012-07-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-0121
Number of participants with account balances2012-07-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-011
2011: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2011 401k membership
Total participants, beginning-of-year2011-07-0119
Total number of active participants reported on line 7a of the Form 55002011-07-0119
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-012
Total of all active and inactive participants2011-07-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-0121
Number of participants with account balances2011-07-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-010
2010: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2010 401k membership
Total participants, beginning-of-year2010-07-0121
Total number of active participants reported on line 7a of the Form 55002010-07-0117
Number of retired or separated participants receiving benefits2010-07-010
Number of other retired or separated participants entitled to future benefits2010-07-013
Total of all active and inactive participants2010-07-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-0120
Number of participants with account balances2010-07-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-07-010
2009: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2009 401k membership
Total participants, beginning-of-year2009-07-0120
Total number of active participants reported on line 7a of the Form 55002009-07-0119
Number of retired or separated participants receiving benefits2009-07-011
Number of other retired or separated participants entitled to future benefits2009-07-012
Total of all active and inactive participants2009-07-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-0122
Number of participants with account balances2009-07-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-07-010

Financial Data on FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS

Measure Date Value
2018 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2018 401k financial data
Total plan liabilities at end of year2018-12-31$0
Total plan liabilities at beginning of year2018-12-31$5,272
Total income from all sources2018-12-31$71,674
Expenses. Total of all expenses incurred2018-12-31$3,374,593
Benefits paid (including direct rollovers)2018-12-31$3,374,593
Total plan assets at end of year2018-12-31$0
Total plan assets at beginning of year2018-12-31$3,308,191
Value of fidelity bond covering the plan2018-12-31$1,000,000
Total contributions received or receivable from participants2018-12-31$0
Other income received2018-12-31$71,674
Net income (gross income less expenses)2018-12-31$-3,302,919
Net plan assets at end of year (total assets less liabilities)2018-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$3,302,919
Total contributions received or receivable from employer(s)2018-12-31$0
2017 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2017 401k financial data
Total plan liabilities at end of year2017-12-31$5,272
Total plan liabilities at beginning of year2017-12-31$14,802
Total income from all sources2017-12-31$233,722
Expenses. Total of all expenses incurred2017-12-31$18,003
Benefits paid (including direct rollovers)2017-12-31$18,000
Total plan assets at end of year2017-12-31$3,308,191
Total plan assets at beginning of year2017-12-31$3,102,002
Value of fidelity bond covering the plan2017-12-31$1,000,000
Expenses. Other expenses not covered elsewhere2017-12-31$3
Other income received2017-12-31$233,722
Net income (gross income less expenses)2017-12-31$215,719
Net plan assets at end of year (total assets less liabilities)2017-12-31$3,302,919
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$3,087,200
2016 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2016 401k financial data
Total plan liabilities at end of year2016-12-31$14,802
Total plan liabilities at beginning of year2016-12-31$182,018
Total income from all sources2016-12-31$168,279
Expenses. Total of all expenses incurred2016-12-31$1,593
Total plan assets at end of year2016-12-31$3,102,002
Total plan assets at beginning of year2016-12-31$3,102,532
Value of fidelity bond covering the plan2016-12-31$1,000,000
Total contributions received or receivable from participants2016-12-31$27,680
Expenses. Other expenses not covered elsewhere2016-12-31$3
Other income received2016-12-31$60,262
Net income (gross income less expenses)2016-12-31$166,686
Net plan assets at end of year (total assets less liabilities)2016-12-31$3,087,200
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$2,920,514
Assets. Value of employer securities2016-12-31$0
Total contributions received or receivable from employer(s)2016-12-31$80,337
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$1,590
Total plan liabilities at end of year2016-06-30$182,018
Total plan liabilities at beginning of year2016-06-30$232,365
Total income from all sources2016-06-30$427,748
Expenses. Total of all expenses incurred2016-06-30$17,192
Total plan assets at end of year2016-06-30$3,102,532
Total plan assets at beginning of year2016-06-30$2,742,323
Value of fidelity bond covering the plan2016-06-30$1,000,000
Total contributions received or receivable from participants2016-06-30$42,808
Expenses. Other expenses not covered elsewhere2016-06-30$14,064
Other income received2016-06-30$277,917
Net income (gross income less expenses)2016-06-30$410,556
Net plan assets at end of year (total assets less liabilities)2016-06-30$2,920,514
Net plan assets at beginning of year (total assets less liabilities)2016-06-30$2,509,958
Assets. Value of employer securities2016-06-30$855,000
Total contributions received or receivable from employer(s)2016-06-30$107,023
Expenses. Administrative service providers (salaries,fees and commissions)2016-06-30$3,128
2015 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2015 401k financial data
Total plan liabilities at end of year2015-06-30$232,365
Total plan liabilities at beginning of year2015-06-30$282,180
Total income from all sources2015-06-30$61,734
Expenses. Total of all expenses incurred2015-06-30$41,505
Benefits paid (including direct rollovers)2015-06-30$21,299
Total plan assets at end of year2015-06-30$2,742,323
Total plan assets at beginning of year2015-06-30$2,771,909
Value of fidelity bond covering the plan2015-06-30$1,000,000
Total contributions received or receivable from participants2015-06-30$41,737
Expenses. Other expenses not covered elsewhere2015-06-30$17,096
Other income received2015-06-30$-75,930
Net income (gross income less expenses)2015-06-30$20,229
Net plan assets at end of year (total assets less liabilities)2015-06-30$2,509,958
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$2,489,729
Assets. Value of employer securities2015-06-30$612,000
Total contributions received or receivable from employer(s)2015-06-30$95,927
Expenses. Administrative service providers (salaries,fees and commissions)2015-06-30$3,110
2014 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2014 401k financial data
Total plan liabilities at end of year2014-06-30$282,180
Total plan liabilities at beginning of year2014-06-30$329,074
Total income from all sources2014-06-30$326,395
Expenses. Total of all expenses incurred2014-06-30$23,015
Total plan assets at end of year2014-06-30$2,771,909
Total plan assets at beginning of year2014-06-30$2,515,423
Value of fidelity bond covering the plan2014-06-30$1,000,000
Total contributions received or receivable from participants2014-06-30$22,800
Expenses. Other expenses not covered elsewhere2014-06-30$19,954
Other income received2014-06-30$229,252
Net income (gross income less expenses)2014-06-30$303,380
Net plan assets at end of year (total assets less liabilities)2014-06-30$2,489,729
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$2,186,349
Assets. Value of participant loans2014-06-30$2,544
Assets. Value of employer securities2014-06-30$555,000
Total contributions received or receivable from employer(s)2014-06-30$74,343
Expenses. Administrative service providers (salaries,fees and commissions)2014-06-30$3,061
2013 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2013 401k financial data
Total plan liabilities at end of year2013-06-30$329,074
Total plan liabilities at beginning of year2013-06-30$374,389
Total income from all sources2013-06-30$273,890
Expenses. Total of all expenses incurred2013-06-30$60,353
Benefits paid (including direct rollovers)2013-06-30$34,804
Total plan assets at end of year2013-06-30$2,515,423
Total plan assets at beginning of year2013-06-30$2,347,201
Value of fidelity bond covering the plan2013-06-30$1,000,000
Total contributions received or receivable from participants2013-06-30$21,900
Expenses. Other expenses not covered elsewhere2013-06-30$22,649
Other income received2013-06-30$183,230
Net income (gross income less expenses)2013-06-30$213,537
Net plan assets at end of year (total assets less liabilities)2013-06-30$2,186,349
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$1,972,812
Assets. Value of employer securities2013-06-30$525,000
Total contributions received or receivable from employer(s)2013-06-30$68,760
Expenses. Administrative service providers (salaries,fees and commissions)2013-06-30$2,900
2012 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2012 401k financial data
Total plan liabilities at end of year2012-06-30$374,389
Total plan liabilities at beginning of year2012-06-30$414,029
Total income from all sources2012-06-30$45,873
Expenses. Total of all expenses incurred2012-06-30$28,811
Total plan assets at end of year2012-06-30$2,347,201
Total plan assets at beginning of year2012-06-30$2,369,779
Value of fidelity bond covering the plan2012-06-30$1,000,000
Total contributions received or receivable from participants2012-06-30$21,000
Expenses. Other expenses not covered elsewhere2012-06-30$28,811
Other income received2012-06-30$-40,185
Net income (gross income less expenses)2012-06-30$17,062
Net plan assets at end of year (total assets less liabilities)2012-06-30$1,972,812
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$1,955,750
Assets. Value of employer securities2012-06-30$522,000
Total contributions received or receivable from employer(s)2012-06-30$65,058
2011 : FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2011 401k financial data
Total plan liabilities at end of year2011-06-30$414,029
Total plan liabilities at beginning of year2011-06-30$457,197
Total income from all sources2011-06-30$204,838
Expenses. Total of all expenses incurred2011-06-30$30,241
Total plan assets at end of year2011-06-30$2,369,779
Total plan assets at beginning of year2011-06-30$2,238,350
Value of fidelity bond covering the plan2011-06-30$1,000,000
Total contributions received or receivable from participants2011-06-30$21,000
Expenses. Other expenses not covered elsewhere2011-06-30$27,111
Other income received2011-06-30$126,718
Net income (gross income less expenses)2011-06-30$174,597
Net plan assets at end of year (total assets less liabilities)2011-06-30$1,955,750
Net plan assets at beginning of year (total assets less liabilities)2011-06-30$1,781,153
Assets. Value of employer securities2011-06-30$432,000
Total contributions received or receivable from employer(s)2011-06-30$57,120
Expenses. Administrative service providers (salaries,fees and commissions)2011-06-30$3,130

Form 5500 Responses for FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS

2018: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 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 filingYes
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 – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 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 - TrustYes
2016: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement - TrustYes
2015: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement - TrustYes
2014: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement - TrustYes
2013: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedYes
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement - TrustYes
2012: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement - TrustYes
2011: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement - TrustYes
2010: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – TrustYes
2010-07-01Plan benefit arrangement - TrustYes
2009: FARRIS EVANS INSURANCE AGENCY, INC. ESOP WITH 401K PROVISIONS 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan 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 number66222
Policy instance 1
Insurance contract or identification number66222
Number of Individuals Covered15
Insurance policy start date2016-07-01
Insurance policy end date2017-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $795
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 fees795
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker organization code?5
Insurance broker name
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66222
Policy instance 1
Insurance contract or identification number66222
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,128
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3128
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker organization code?5
Insurance broker name
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66222
Policy instance 1
Insurance contract or identification number66222
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,110
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Insurance broker organization code?6
Amount paid for insurance broker fees3110
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker nameBENEFIT RESOURCES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66222
Policy instance 1
Insurance contract or identification number66222
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $6,752
Total amount of fees paid to insurance companyUSD $428
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Additional information about fees paid to insurance brokerBROKERAGE
Insurance broker organization code?6
Amount paid for insurance broker fees3061
Insurance broker nameBENEFIT RESOURCES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66222
Policy instance 1
Insurance contract or identification number66222
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $6,153
Total amount of fees paid to insurance companyUSD $396
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $6,153
Additional information about fees paid to insurance brokerBROKERAGE
Insurance broker organization code?6
Amount paid for insurance broker fees396
Insurance broker nameBENEFIT RESOURCES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66222
Policy instance 1
Insurance contract or identification number66222
Number of Individuals Covered13
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $3,842
Total amount of fees paid to insurance companyUSD $396
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number66222
Policy instance 1
Insurance contract or identification number66222
Number of Individuals Covered13
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $3,426
Total amount of fees paid to insurance companyUSD $396
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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