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CHHJ FRANCHISING, L.L.C. 401(K) PLAN 401k Plan overview

Plan NameCHHJ FRANCHISING, L.L.C. 401(K) PLAN
Plan identification number 001

CHHJ FRANCHISING, L.L.C. 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.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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

CHHJ FRANCHISING L.L.C. has sponsored the creation of one or more 401k plans.

Company Name:CHHJ FRANCHISING L.L.C.
Employer identification number (EIN):870789542
NAIC Classification:533110
NAIC Description:Lessors of Nonfinancial Intangible Assets (except Copyrighted Works)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHHJ FRANCHISING, L.L.C. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01ONIX FIGUREROA VALENTIN2023-09-08
0012021-01-01ONIX FIGUREROA VALENTIN2022-10-07
0012020-01-01ROMAN COWAN2021-10-11
0012019-06-01
0012019-06-01ROMAN COWAN2021-10-11

Plan Statistics for CHHJ FRANCHISING, L.L.C. 401(K) PLAN

401k plan membership statisitcs for CHHJ FRANCHISING, L.L.C. 401(K) PLAN

Measure Date Value
2022: CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01274
Total number of active participants reported on line 7a of the Form 55002022-01-01215
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0141
Total of all active and inactive participants2022-01-01256
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01256
Number of participants with account balances2022-01-01239
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0198
2021: CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01171
Total number of active participants reported on line 7a of the Form 55002021-01-01215
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0159
Total of all active and inactive participants2021-01-01274
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01274
Number of participants with account balances2021-01-01237
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0186
2020: CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01145
Total number of active participants reported on line 7a of the Form 55002020-01-01145
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0126
Total of all active and inactive participants2020-01-01171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01171
Number of participants with account balances2020-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0160
2019: CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01105
Total number of active participants reported on line 7a of the Form 55002019-06-01137
Number of retired or separated participants receiving benefits2019-06-010
Number of other retired or separated participants entitled to future benefits2019-06-018
Total of all active and inactive participants2019-06-01145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-06-010
Total participants2019-06-01145
Number of participants with account balances2019-06-01127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-06-0117

Financial Data on CHHJ FRANCHISING, L.L.C. 401(K) PLAN

Measure Date Value
2022 : CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$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
Total income from all sources (including contributions)2022-12-31$711,281
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$197,696
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$164,350
Expenses. Certain deemed distributions of participant loans2022-12-31$1,415
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,040,748
Value of total assets at end of year2022-12-31$2,469,724
Value of total assets at beginning of year2022-12-31$1,956,139
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$31,931
Total interest from all sources2022-12-31$2,494
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$27,965
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$27,965
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 period2022-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$646,367
Participant contributions at end of year2022-12-31$77,627
Participant contributions at beginning of year2022-12-31$31,998
Participant contributions at end of year2022-12-31$5,264
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$28,509
Other income not declared elsewhere2022-12-31$7,718
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$9,668
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
Value of net income/loss2022-12-31$513,585
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,469,724
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,956,139
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
Investment advisory and management fees2022-12-31$9,493
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$2,334,229
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$1,905,135
Interest on participant loans2022-12-31$2,408
Interest earned on other investments2022-12-31$86
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$49,028
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-367,644
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 contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$365,872
Employer contributions (assets) at end of year2022-12-31$3,576
Employer contributions (assets) at beginning of year2022-12-31$9,338
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$164,350
Contract administrator fees2022-12-31$22,438
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31Yes
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
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31ASSURANCE DIMENSIONS
Accountancy firm EIN2022-12-31263429295
2021 : CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$950,246
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$89,094
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$35,786
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$738,195
Value of total assets at end of year2021-12-31$1,956,139
Value of total assets at beginning of year2021-12-31$1,094,987
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$53,308
Total interest from all sources2021-12-31$805
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Administrative expenses professional fees incurred2021-12-31$3,909
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$473,554
Participant contributions at end of year2021-12-31$31,998
Participant contributions at beginning of year2021-12-31$11,260
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$16,047
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-12-31$0
Administrative expenses (other) incurred2021-12-31$25,056
Total non interest bearing cash at end of year2021-12-31$9,668
Total non interest bearing cash at beginning of year2021-12-31$24,819
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$861,152
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,956,139
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,094,987
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$300
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$1,905,135
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$1,053,156
Interest on participant loans2021-12-31$805
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$211,246
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$248,594
Employer contributions (assets) at end of year2021-12-31$9,338
Employer contributions (assets) at beginning of year2021-12-31$5,752
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$35,786
Contract administrator fees2021-12-31$24,043
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31ASSURANCE DIMENSIONS
Accountancy firm EIN2021-12-31263429295
2020 : CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$674,673
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$108,141
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$90,922
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$525,043
Value of total assets at end of year2020-12-31$1,094,987
Value of total assets at beginning of year2020-12-31$528,455
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$17,219
Total interest from all sources2020-12-31$555
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$342,845
Participant contributions at end of year2020-12-31$11,260
Participant contributions at beginning of year2020-12-31$7,011
Total non interest bearing cash at end of year2020-12-31$24,819
Total non interest bearing cash at beginning of year2020-12-31$5,828
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$566,532
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,094,987
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$528,455
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$1,053,156
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$515,616
Interest on participant loans2020-12-31$555
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$149,075
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$182,198
Employer contributions (assets) at end of year2020-12-31$5,752
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$90,922
Contract administrator fees2020-12-31$17,219
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31ASSURANCE DIMENSIONS
Accountancy firm EIN2020-12-31263429295
2019 : CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets to this plan2019-12-31$136,637
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$413,179
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$21,361
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$16,894
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$378,135
Value of total assets at end of year2019-12-31$528,455
Value of total assets at beginning of year2019-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$4,467
Total interest from all sources2019-12-31$198
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$166,056
Participant contributions at end of year2019-12-31$7,011
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$136,624
Total non interest bearing cash at end of year2019-12-31$5,828
Total non interest bearing cash at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$391,818
Value of net assets at end of year (total assets less liabilities)2019-12-31$528,455
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$515,616
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$0
Interest on participant loans2019-12-31$198
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$34,846
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$75,455
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$16,894
Contract administrator fees2019-12-31$4,467
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31ASSURANCE DIMENSIONS
Accountancy firm EIN2019-12-31263429295

Form 5500 Responses for CHHJ FRANCHISING, L.L.C. 401(K) PLAN

2022: CHHJ FRANCHISING, L.L.C. 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 – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CHHJ FRANCHISING, L.L.C. 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: CHHJ FRANCHISING, L.L.C. 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: CHHJ FRANCHISING, L.L.C. 401(K) PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01First time form 5500 has been submittedYes
2019-06-01Submission has been amendedYes
2019-06-01This submission is the final filingNo
2019-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-06-01Plan is a collectively bargained planNo
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – TrustYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan 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 number140282
Policy instance 1
Insurance contract or identification number140282
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-09-26
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,020
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 fees4020
Additional information about fees paid to insurance brokerTPA FEES AND COMPENSATION
Insurance broker organization code?5
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number517511-01
Policy instance 2
Insurance contract or identification number517511-01
Number of Individuals Covered199
Insurance policy start date2022-09-27
Insurance policy end date2022-12-31
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number140282
Policy instance 1
Insurance contract or identification number140282
Number of Individuals Covered238
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $7,251
Total amount of fees paid to insurance companyUSD $4,680
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
Commission paid to Insurance BrokerUSD $7,251
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number140282
Policy instance 1
Insurance contract or identification number140282
Number of Individuals Covered135
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,465
Total amount of fees paid to insurance companyUSD $7,877
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 fees7877
Additional information about fees paid to insurance brokerTPA FEES AND COMPENSATION
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $3,465
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number140282
Policy instance 1
Insurance contract or identification number140282
Number of Individuals Covered127
Insurance policy start date2019-06-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $682
Total amount of fees paid to insurance companyUSD $3,365
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

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