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USHR INC. 401(K) PLAN 401k Plan overview

Plan NameUSHR INC. 401(K) PLAN
Plan identification number 001

USHR INC. 401(K) PLAN Benefits

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

401k Sponsoring company profile

USHR INC. has sponsored the creation of one or more 401k plans.

Company Name:USHR INC.
Employer identification number (EIN):814612156
NAIC Classification:541512
NAIC Description:Computer Systems Design Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan USHR INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01HEATHER FROGGE

Plan Statistics for USHR INC. 401(K) PLAN

401k plan membership statisitcs for USHR INC. 401(K) PLAN

Measure Date Value
2022: USHR INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01125
Total number of active participants reported on line 7a of the Form 55002022-01-01142
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0116
Total of all active and inactive participants2022-01-01158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01158
Number of participants with account balances2022-01-01120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: USHR INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0187
Total number of active participants reported on line 7a of the Form 55002021-01-01116
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-019
Total of all active and inactive participants2021-01-01125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01125
Number of participants with account balances2021-01-0187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: USHR INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0172
Total number of active participants reported on line 7a of the Form 55002020-01-0179
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-018
Total of all active and inactive participants2020-01-0187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0187
Number of participants with account balances2020-01-0169
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: USHR INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0147
Total number of active participants reported on line 7a of the Form 55002019-01-0165
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-016
Total of all active and inactive participants2019-01-0171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0171
Number of participants with account balances2019-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: USHR INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0132
Total number of active participants reported on line 7a of the Form 55002018-01-0141
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-015
Total of all active and inactive participants2018-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0146
Number of participants with account balances2018-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010

Financial Data on USHR INC. 401(K) PLAN

Measure Date Value
2022 : USHR INC. 401(K) PLAN 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$0
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$0
Total transfer of assets from this plan2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Expenses. Interest paid2022-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022022-12-31$0
Total income from all sources (including contributions)2022-12-31$474,305
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$314,932
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$291,728
Expenses. Certain deemed distributions of participant loans2022-12-31$0
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,384,576
Value of total assets at end of year2022-12-31$5,307,340
Value of total assets at beginning of year2022-12-31$5,147,967
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$23,204
Total income from rents2022-12-31$0
Total interest from all sources2022-12-31$1,968
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$413,085
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$413,085
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Administrative expenses professional fees incurred2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$977,015
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$34,998
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$22,801
Liabilities. Value of operating payables at end of year2022-12-31$0
Liabilities. Value of operating payables at beginning of year2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$159,373
Value of net assets at end of year (total assets less liabilities)2022-12-31$5,307,340
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$5,147,967
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Investment advisory and management fees2022-12-31$403
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$5,164,066
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$5,077,254
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$0
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$0
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$143,274
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$70,713
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$70,713
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$1,968
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,325,324
Net investment gain/loss from pooled separate accounts2022-12-31$0
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$372,563
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$291,728
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WINDHAM BRANNON, LLC
Accountancy firm EIN2022-12-31581763439
2021 : USHR INC. 401(K) PLAN 2021 401k financial data
Transfers to/from the plan2021-12-31$0
Total plan liabilities at end of year2021-12-31$0
Total plan liabilities at beginning of year2021-12-31$0
Total income from all sources2021-12-31$2,048,372
Expenses. Total of all expenses incurred2021-12-31$265,592
Benefits paid (including direct rollovers)2021-12-31$254,481
Total plan assets at end of year2021-12-31$5,147,967
Total plan assets at beginning of year2021-12-31$3,365,187
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$718,570
Expenses. Other expenses not covered elsewhere2021-12-31$0
Contributions received from other sources (not participants or employers)2021-12-31$704,846
Other income received2021-12-31$326,185
Noncash contributions received2021-12-31$0
Net income (gross income less expenses)2021-12-31$1,782,780
Net plan assets at end of year (total assets less liabilities)2021-12-31$5,147,967
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$3,365,187
Total contributions received or receivable from employer(s)2021-12-31$298,771
Value of certain deemed distributions of participant loans2021-12-31$0
Value of corrective distributions2021-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$11,111
2020 : USHR INC. 401(K) PLAN 2020 401k financial data
Total income from all sources2020-12-31$1,374,638
Expenses. Total of all expenses incurred2020-12-31$76,050
Benefits paid (including direct rollovers)2020-12-31$62,766
Total plan assets at end of year2020-12-31$3,365,187
Total plan assets at beginning of year2020-12-31$2,066,599
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$649,207
Contributions received from other sources (not participants or employers)2020-12-31$26,128
Other income received2020-12-31$446,612
Net income (gross income less expenses)2020-12-31$1,298,588
Net plan assets at end of year (total assets less liabilities)2020-12-31$3,365,187
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$2,066,599
Total contributions received or receivable from employer(s)2020-12-31$252,691
Value of corrective distributions2020-12-31$3,314
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$9,970
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : USHR INC. 401(K) PLAN 2019 401k financial data
Total income from all sources2019-12-31$1,380,443
Expenses. Total of all expenses incurred2019-12-31$25,032
Benefits paid (including direct rollovers)2019-12-31$20,405
Total plan assets at end of year2019-12-31$2,066,599
Total plan assets at beginning of year2019-12-31$711,188
Value of fidelity bond covering the plan2019-12-31$500,000
Total contributions received or receivable from participants2019-12-31$361,716
Contributions received from other sources (not participants or employers)2019-12-31$726,891
Other income received2019-12-31$243,296
Net income (gross income less expenses)2019-12-31$1,355,411
Net plan assets at end of year (total assets less liabilities)2019-12-31$2,066,599
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$711,188
Total contributions received or receivable from employer(s)2019-12-31$48,540
Value of corrective distributions2019-12-31$2,885
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$1,742
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : USHR INC. 401(K) PLAN 2018 401k financial data
Transfers to/from the plan2018-12-31$529,858
Total income from all sources2018-12-31$245,499
Expenses. Total of all expenses incurred2018-12-31$64,169
Benefits paid (including direct rollovers)2018-12-31$64,069
Total plan assets at end of year2018-12-31$711,188
Total plan assets at beginning of year2018-12-31$0
Value of fidelity bond covering the plan2018-12-31$500,000
Total contributions received or receivable from participants2018-12-31$267,351
Contributions received from other sources (not participants or employers)2018-12-31$674
Other income received2018-12-31$-58,735
Net income (gross income less expenses)2018-12-31$181,330
Net plan assets at end of year (total assets less liabilities)2018-12-31$711,188
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$0
Total contributions received or receivable from employer(s)2018-12-31$36,209
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$100
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0

Form 5500 Responses for USHR INC. 401(K) PLAN

2022: USHR INC. 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: USHR INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: USHR INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: USHR INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: USHR INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number132708
Policy instance 1
Insurance contract or identification number132708
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-02-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $140
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees140
Additional information about fees paid to insurance brokerFEE
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number132708
Policy instance 1
Insurance contract or identification number132708
Number of Individuals Covered69
Insurance policy start date2020-01-02
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,193
Total amount of fees paid to insurance companyUSD $1,228
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,193
Insurance broker organization code?3
Amount paid for insurance broker fees1228
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 number132708
Policy instance 1
Insurance contract or identification number132708
Number of Individuals Covered54
Insurance policy start date2019-01-02
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,282
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1667
Additional information about fees paid to insurance brokerTPA FEED PAID
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number132708
Policy instance 1
Insurance contract or identification number132708
Number of Individuals Covered32
Insurance policy start date2018-01-02
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $364
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees314
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker organization code?5

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