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HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameHAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN
Plan identification number 001

HAZEN SUPPLIERS, INC. 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
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

HAZEN SUPPLIERS, INC. has sponsored the creation of one or more 401k plans.

Company Name:HAZEN SUPPLIERS, INC.
Employer identification number (EIN):770168767
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01ERISA FIDUCIARY SERVICES2023-04-07
0012021-01-01JAMES HAZEN2022-04-22
0012021-01-01ERISA FIDUCIARY SERVICES2022-07-13
0012020-10-01ERISA FIDUCIARY SERVICES, INC2021-06-28
0012018-10-01
0012017-10-01
0012016-10-01
0012015-10-01
0012014-10-01
0012013-10-01J. BLAKE HAZEN
0012012-10-01J. BRENT HAZEN
0012011-10-01J. BRENT HAZEN
0012009-10-01DOUGLAS S. HENDRY

Plan Statistics for HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2017: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-0110
Total number of active participants reported on line 7a of the Form 55002017-10-019
Number of other retired or separated participants entitled to future benefits2017-10-011
Total of all active and inactive participants2017-10-0110
Total participants2017-10-0110
Number of participants with account balances2017-10-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-10-010
2016: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-0111
Total number of active participants reported on line 7a of the Form 55002016-10-019
Number of other retired or separated participants entitled to future benefits2016-10-011
Total of all active and inactive participants2016-10-0110
Total participants2016-10-0110
Number of participants with account balances2016-10-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-10-010
2015: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-0111
Total number of active participants reported on line 7a of the Form 55002015-10-019
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-012
Total of all active and inactive participants2015-10-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-10-010
Total participants2015-10-0111
Number of participants with account balances2015-10-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-10-010
2014: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-0111
Total number of active participants reported on line 7a of the Form 55002014-10-0110
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-011
Total of all active and inactive participants2014-10-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-10-010
Total participants2014-10-0111
Number of participants with account balances2014-10-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-10-010
2013: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-0113
Total number of active participants reported on line 7a of the Form 55002013-10-0111
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-10-010
Total participants2013-10-0111
Number of participants with account balances2013-10-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-10-010
2012: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-0112
Total number of active participants reported on line 7a of the Form 55002012-10-0112
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-011
Total of all active and inactive participants2012-10-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-10-010
Total participants2012-10-0113
Number of participants with account balances2012-10-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-10-010
2011: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-0112
Total number of active participants reported on line 7a of the Form 55002011-10-0111
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-011
Total of all active and inactive participants2011-10-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-10-010
Total participants2011-10-0112
Number of participants with account balances2011-10-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-10-011
2009: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-0111
Total number of active participants reported on line 7a of the Form 55002009-10-0110
Number of retired or separated participants receiving benefits2009-10-010
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-10-011
Total participants2009-10-0111
Number of participants with account balances2009-10-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-10-010

Financial Data on HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2018 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-09-30$137,461
Expenses. Total of all expenses incurred2018-09-30$105,040
Benefits paid (including direct rollovers)2018-09-30$99,956
Total plan assets at end of year2018-09-30$1,235,081
Total plan assets at beginning of year2018-09-30$1,202,660
Value of fidelity bond covering the plan2018-09-30$100,000
Total contributions received or receivable from participants2018-09-30$45,316
Other income received2018-09-30$73,157
Net income (gross income less expenses)2018-09-30$32,421
Net plan assets at end of year (total assets less liabilities)2018-09-30$1,235,081
Net plan assets at beginning of year (total assets less liabilities)2018-09-30$1,202,660
Total contributions received or receivable from employer(s)2018-09-30$18,988
Expenses. Administrative service providers (salaries,fees and commissions)2018-09-30$5,084
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-09-30$0
2017 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at end of year2017-09-30$0
Total plan liabilities at beginning of year2017-09-30$0
Total income from all sources2017-09-30$192,242
Expenses. Total of all expenses incurred2017-09-30$134,588
Benefits paid (including direct rollovers)2017-09-30$129,847
Total plan assets at end of year2017-09-30$1,202,660
Total plan assets at beginning of year2017-09-30$1,145,006
Value of fidelity bond covering the plan2017-09-30$100,000
Total contributions received or receivable from participants2017-09-30$42,084
Expenses. Other expenses not covered elsewhere2017-09-30$257
Other income received2017-09-30$132,927
Net income (gross income less expenses)2017-09-30$57,654
Net plan assets at end of year (total assets less liabilities)2017-09-30$1,202,660
Net plan assets at beginning of year (total assets less liabilities)2017-09-30$1,145,006
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022017-09-30$1,218
Total contributions received or receivable from employer(s)2017-09-30$17,231
Expenses. Administrative service providers (salaries,fees and commissions)2017-09-30$4,484
2016 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year2016-09-30$0
Total plan liabilities at beginning of year2016-09-30$0
Total income from all sources2016-09-30$155,287
Expenses. Total of all expenses incurred2016-09-30$40,383
Benefits paid (including direct rollovers)2016-09-30$40,383
Total plan assets at end of year2016-09-30$1,145,006
Total plan assets at beginning of year2016-09-30$1,030,102
Value of fidelity bond covering the plan2016-09-30$100,000
Total contributions received or receivable from participants2016-09-30$45,759
Other income received2016-09-30$92,319
Net income (gross income less expenses)2016-09-30$114,904
Net plan assets at end of year (total assets less liabilities)2016-09-30$1,145,006
Net plan assets at beginning of year (total assets less liabilities)2016-09-30$1,030,102
Total contributions received or receivable from employer(s)2016-09-30$17,209
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-09-30$0
2015 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at beginning of year2015-09-30$0
Total income from all sources2015-09-30$40,130
Expenses. Total of all expenses incurred2015-09-30$47,496
Benefits paid (including direct rollovers)2015-09-30$43,319
Total plan assets at end of year2015-09-30$1,030,102
Total plan assets at beginning of year2015-09-30$1,037,468
Value of fidelity bond covering the plan2015-09-30$103,000
Total contributions received or receivable from participants2015-09-30$53,726
Other income received2015-09-30$-31,220
Net income (gross income less expenses)2015-09-30$-7,366
Net plan assets at end of year (total assets less liabilities)2015-09-30$1,030,102
Net plan assets at beginning of year (total assets less liabilities)2015-09-30$1,037,468
Total contributions received or receivable from employer(s)2015-09-30$17,624
Expenses. Administrative service providers (salaries,fees and commissions)2015-09-30$4,177
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-09-30$0
2014 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-09-30$0
Total plan liabilities at end of year2014-09-30$0
Total plan liabilities at beginning of year2014-09-30$0
Total income from all sources2014-09-30$138,557
Expenses. Total of all expenses incurred2014-09-30$118,810
Benefits paid (including direct rollovers)2014-09-30$113,992
Total plan assets at end of year2014-09-30$1,037,468
Total plan assets at beginning of year2014-09-30$1,017,721
Value of fidelity bond covering the plan2014-09-30$104,000
Total contributions received or receivable from participants2014-09-30$35,574
Expenses. Other expenses not covered elsewhere2014-09-30$4,818
Contributions received from other sources (not participants or employers)2014-09-30$0
Other income received2014-09-30$87,882
Noncash contributions received2014-09-30$0
Net income (gross income less expenses)2014-09-30$19,747
Net plan assets at end of year (total assets less liabilities)2014-09-30$1,037,468
Net plan assets at beginning of year (total assets less liabilities)2014-09-30$1,017,721
Total contributions received or receivable from employer(s)2014-09-30$15,101
Value of certain deemed distributions of participant loans2014-09-30$0
Value of corrective distributions2014-09-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-09-30$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-09-30$0
2013 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan2013-09-30$0
Total plan liabilities at end of year2013-09-30$0
Total plan liabilities at beginning of year2013-09-30$0
Total income from all sources2013-09-30$161,404
Expenses. Total of all expenses incurred2013-09-30$46,066
Benefits paid (including direct rollovers)2013-09-30$38,606
Total plan assets at end of year2013-09-30$1,017,721
Total plan assets at beginning of year2013-09-30$902,383
Value of fidelity bond covering the plan2013-09-30$100,000
Total contributions received or receivable from participants2013-09-30$35,355
Expenses. Other expenses not covered elsewhere2013-09-30$7,460
Contributions received from other sources (not participants or employers)2013-09-30$0
Other income received2013-09-30$108,485
Noncash contributions received2013-09-30$0
Net income (gross income less expenses)2013-09-30$115,338
Net plan assets at end of year (total assets less liabilities)2013-09-30$1,017,721
Net plan assets at beginning of year (total assets less liabilities)2013-09-30$902,383
Total contributions received or receivable from employer(s)2013-09-30$17,564
Value of certain deemed distributions of participant loans2013-09-30$0
Value of corrective distributions2013-09-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-09-30$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-09-30$0
2012 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan2012-09-30$0
Total plan liabilities at end of year2012-09-30$0
Total plan liabilities at beginning of year2012-09-30$0
Total income from all sources2012-09-30$576,952
Expenses. Total of all expenses incurred2012-09-30$715,505
Benefits paid (including direct rollovers)2012-09-30$705,982
Total plan assets at end of year2012-09-30$902,383
Total plan assets at beginning of year2012-09-30$1,040,936
Value of fidelity bond covering the plan2012-09-30$100,000
Total contributions received or receivable from participants2012-09-30$29,476
Expenses. Other expenses not covered elsewhere2012-09-30$9,523
Contributions received from other sources (not participants or employers)2012-09-30$306,186
Other income received2012-09-30$192,313
Noncash contributions received2012-09-30$0
Net income (gross income less expenses)2012-09-30$-138,553
Net plan assets at end of year (total assets less liabilities)2012-09-30$902,383
Net plan assets at beginning of year (total assets less liabilities)2012-09-30$1,040,936
Total contributions received or receivable from employer(s)2012-09-30$48,977
Value of certain deemed distributions of participant loans2012-09-30$0
Value of corrective distributions2012-09-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-09-30$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-09-30$679,866
2011 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-09-30$0
Total plan liabilities at end of year2011-09-30$0
Total plan liabilities at beginning of year2011-09-30$0
Total income from all sources2011-09-30$116,804
Expenses. Total of all expenses incurred2011-09-30$42,862
Benefits paid (including direct rollovers)2011-09-30$31,687
Total plan assets at end of year2011-09-30$1,040,936
Total plan assets at beginning of year2011-09-30$966,994
Value of fidelity bond covering the plan2011-09-30$100,000
Total contributions received or receivable from participants2011-09-30$53,216
Expenses. Other expenses not covered elsewhere2011-09-30$11,175
Contributions received from other sources (not participants or employers)2011-09-30$0
Other income received2011-09-30$-3,232
Noncash contributions received2011-09-30$0
Net income (gross income less expenses)2011-09-30$73,942
Net plan assets at end of year (total assets less liabilities)2011-09-30$1,040,936
Net plan assets at beginning of year (total assets less liabilities)2011-09-30$966,994
Total contributions received or receivable from employer(s)2011-09-30$66,820
Value of certain deemed distributions of participant loans2011-09-30$0
Value of corrective distributions2011-09-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-09-30$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-09-30$0
2010 : HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-09-30$0

Form 5500 Responses for HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN

2017: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement - TrustYes
2016: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes
2015: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement - TrustYes
2014: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement - TrustYes
2013: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement - TrustYes
2012: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement - TrustYes
2011: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement - TrustYes
2009: HAZEN SUPPLIERS, INC. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – TrustYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan 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 number36953
Policy instance 1
Insurance contract or identification number36953
Number of Individuals Covered9
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $4,779
Total amount of fees paid to insurance companyUSD $897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,779
Insurance broker organization code?3
Amount paid for insurance broker fees897
Insurance broker namePENSYS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36953
Policy instance 1
Insurance contract or identification number36953
Number of Individuals Covered11
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $4,599
Total amount of fees paid to insurance companyUSD $268
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 $4,599
Insurance broker organization code?3
Amount paid for insurance broker fees268
Insurance broker namePENSYS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36953
Policy instance 1
Insurance contract or identification number36953
Number of Individuals Covered11
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $4,180
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 $4,180
Insurance broker organization code?3
Insurance broker nameRAYMOND JAMES INSURANCE GROUP, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36953
Policy instance 1
Insurance contract or identification number36953
Number of Individuals Covered11
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $4,125
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,125
Insurance broker organization code?3
Insurance broker nameRAYMOND JAMES INSURANCE GROUP, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36953
Policy instance 1
Insurance contract or identification number36953
Number of Individuals Covered11
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $3,442
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,442
Insurance broker organization code?3
Insurance broker namePLANNING CORP OF AMERICA
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36953
Policy instance 1
Insurance contract or identification number36953
Number of Individuals Covered12
Insurance policy start date2011-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $7,232
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number36953
Policy instance 1
Insurance contract or identification number36953
Number of Individuals Covered10
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $8,218
Total amount of fees paid to insurance companyUSD $120
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?Yes
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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