401k Plan data: ESSENCE VENTURES, LLC 401(K) PLAN plan

ESSENCE VENTURES, LLC 401(K) PLAN 401k Plan overview

Plan Name	ESSENCE VENTURES, LLC 401(K) PLAN
Plan identification number	001

ESSENCE VENTURES, LLC 401(K) PLAN Benefits

401k Plan Type

Defined 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.
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

ESSENCE VENTURES, LLC has sponsored the creation of one or more 401k plans.

Company Name: ESSENCE VENTURES, LLC

Employer identification number (EIN): 823418584

NAIC Classification: 519100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ESSENCE VENTURES, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MARTHA DENNIS 2023-10-10
001 2021-01-01 MARTHA DENNIS 2022-10-10
001 2020-01-01 AKELA JOHNNY 2021-10-06
001 2019-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	MARTHA DENNIS	2023-10-10
001	2021-01-01	MARTHA DENNIS	2022-10-10
001	2020-01-01	AKELA JOHNNY	2021-10-06
001	2019-01-01

Plan Statistics for ESSENCE VENTURES, LLC 401(K) PLAN

401k plan membership statisitcs for ESSENCE VENTURES, LLC 401(K) PLAN

Measure Date Value
2022: ESSENCE VENTURES, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 92
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 86
Total of all active and inactive participants 2022-01-01 178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 178
Number of participants with account balances 2022-01-01 173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 15
2021: ESSENCE VENTURES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 112
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 60
Total of all active and inactive participants 2021-01-01 172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 172
Number of participants with account balances 2021-01-01 153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 6
2020: ESSENCE VENTURES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 70
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 88
Total of all active and inactive participants 2020-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 158
Number of participants with account balances 2020-01-01 148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 20

Measure	Date	Value
2022: ESSENCE VENTURES, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	92
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	86
Total of all active and inactive participants	2022-01-01	178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	178
Number of participants with account balances	2022-01-01	173
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	15
2021: ESSENCE VENTURES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	112
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	60
Total of all active and inactive participants	2021-01-01	172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	172
Number of participants with account balances	2021-01-01	153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	6
2020: ESSENCE VENTURES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	70
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	88
Total of all active and inactive participants	2020-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	158
Number of participants with account balances	2020-01-01	148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	20

Financial Data on ESSENCE VENTURES, LLC 401(K) PLAN

Measure	Date	Value
2022 : ESSENCE VENTURES, LLC 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$3,830
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$14,009
Total income from all sources (including contributions)	2022-12-31	$459,662
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$977,770
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$904,288
Expenses. Certain deemed distributions of participant loans	2022-12-31	$29,619
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,070,555
Value of total assets at end of year	2022-12-31	$3,310,168
Value of total assets at beginning of year	2022-12-31	$3,838,455
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$43,863
Total interest from all sources	2022-12-31	$1,423
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$584,977
Participant contributions at end of year	2022-12-31	$802
Participant contributions at beginning of year	2022-12-31	$1,550
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$73,005
Assets. Loans (other than to participants) at end of year	2022-12-31	$42,720
Assets. Loans (other than to participants) at beginning of year	2022-12-31	$35,115
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-518,108
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,306,338
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,824,446
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$43,863
Value of interest in pooled separate accounts at end of year	2022-12-31	$3,241,477
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$3,671,252
Interest on participant loans	2022-12-31	$1,423
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$17,263
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$27,345
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$27,345
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$0
Net investment gain/loss from pooled separate accounts	2022-12-31	$-612,316
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$412,573
Employer contributions (assets) at end of year	2022-12-31	$7,906
Employer contributions (assets) at beginning of year	2022-12-31	$103,193
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$904,288
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$3,830
Liabilities. Value of benefit claims payable at beginning of year	2022-12-31	$14,009
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MORGENSTERN, WAXMAN, ELLERSHAW LLC
Accountancy firm EIN	2022-12-31	814670608
2021 : ESSENCE VENTURES, LLC 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$14,009
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$29,515
Total income from all sources (including contributions)	2021-12-31	$1,396,681
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$751,263
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$701,458
Value of total corrective distributions	2021-12-31	$3,842
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$931,299
Value of total assets at end of year	2021-12-31	$3,838,455
Value of total assets at beginning of year	2021-12-31	$3,208,543
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$45,963
Total interest from all sources	2021-12-31	$1,377
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$475,875
Participant contributions at end of year	2021-12-31	$1,550
Participant contributions at beginning of year	2021-12-31	$25,129
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$112,941
Assets. Loans (other than to participants) at end of year	2021-12-31	$35,115
Assets. Loans (other than to participants) at beginning of year	2021-12-31	$43,301
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$645,418
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,824,446
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,179,028
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$3,671,252
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$3,115,709
Interest on participant loans	2021-12-31	$1,377
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$27,345
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$534
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$534
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$0
Net investment gain/loss from pooled separate accounts	2021-12-31	$464,005
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$342,483
Employer contributions (assets) at end of year	2021-12-31	$103,193
Employer contributions (assets) at beginning of year	2021-12-31	$23,870
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$701,458
Contract administrator fees	2021-12-31	$45,963
Liabilities. Value of benefit claims payable at end of year	2021-12-31	$14,009
Liabilities. Value of benefit claims payable at beginning of year	2021-12-31	$29,515
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MORGENSTERN, WAXMAN, ELLERSHAW LLC
Accountancy firm EIN	2021-12-31	814670608
2020 : ESSENCE VENTURES, LLC 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$29,515
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$15,670
Total income from all sources (including contributions)	2020-12-31	$2,004,001
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$455,482
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$422,608
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,565,888
Value of total assets at end of year	2020-12-31	$3,208,543
Value of total assets at beginning of year	2020-12-31	$1,646,179
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$32,874
Total interest from all sources	2020-12-31	$1,686
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	No
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$653,302
Participant contributions at end of year	2020-12-31	$25,129
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$456,655
Assets. Loans (other than to participants) at end of year	2020-12-31	$43,301
Assets. Loans (other than to participants) at beginning of year	2020-12-31	$31,263
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$1,548,519
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,179,028
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,630,509
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$3,115,709
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$1,614,916
Interest on participant loans	2020-12-31	$1,686
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$534
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Net investment gain/loss from pooled separate accounts	2020-12-31	$436,427
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$455,931
Employer contributions (assets) at end of year	2020-12-31	$23,870
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$422,608
Contract administrator fees	2020-12-31	$32,874
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$29,515
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$15,670
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	MORGENSTERN, WAXMAN, ELLERSHAW LLC
Accountancy firm EIN	2020-12-31	814670608

Form 5500 Responses for ESSENCE VENTURES, LLC 401(K) PLAN

2022: ESSENCE VENTURES, LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: ESSENCE VENTURES, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: ESSENCE VENTURES, LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

802116

Policy instance

Insurance contract or identification number	802116
Number of Individuals Covered	197
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $23,877
Total amount of fees paid to insurance company	USD $3,713
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $23,877
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

802116

Policy instance

Insurance contract or identification number	802116
Number of Individuals Covered	173
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $24,822
Total amount of fees paid to insurance company	USD $3,424
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $24,822
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

802116

Policy instance

Insurance contract or identification number	802116
Number of Individuals Covered	167
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $15,744
Total amount of fees paid to insurance company	USD $3,956
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $15,744
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	5

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Company Name:	ESSENCE VENTURES, LLC
Employer identification number (EIN):	823418584
NAIC Classification:	519100