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AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 401k Plan overview

Plan NameAMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN
Plan identification number 002

AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Stock bonus
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • ESOP other than a leveraged ESOP - A completed Schedule E must be attached to a Form 5500 filed for an Employee Stock Ownership Plan (ESOP).
  • Plan requiring that all or part of employer contributions be invested and held, at least for a limited period, in employer securities.

401k Sponsoring company profile

AMERICAN ARIUM has sponsored the creation of one or more 401k plans.

Company Name:AMERICAN ARIUM
Employer identification number (EIN):953464026
NAIC Classification:335900

Additional information about AMERICAN ARIUM

Jurisdiction of Incorporation: California Department of State
Incorporation Date: 1977-02-17
Company Identification Number: C0809879
Legal Registered Office Address: 14811 Myford Road

Tustin
United States of America (USA)
92780

More information about AMERICAN ARIUM

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022017-01-01NICHOLAS L. SAAKVITNE NICHOLAS L. SAAKVITNE2018-09-14
0022016-01-01NICHOLAS L. SAAKVITNE
0022015-01-01NICHOLAS L. SAAKVITNE
0022014-01-01NICHOLAS L. SAAKVITNE
0022013-01-01NICHOLAS SAAKVITNE
0022012-01-01LAWRENCE TRAYLOR
0022011-01-01LAWRENCE TRAYLOR
0022009-01-01DIANE I. DIRKS DIANE I. DIRKS2010-10-05

Plan Statistics for AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN

401k plan membership statisitcs for AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN

Measure Date Value
2017: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0136
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-015
Total of all active and inactive participants2017-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-015
Number of participants with account balances2017-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0136
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0136
Total of all active and inactive participants2016-01-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0136
Number of participants with account balances2016-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0136
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0136
Total of all active and inactive participants2015-01-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0136
Number of participants with account balances2015-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0136
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0136
Total of all active and inactive participants2014-01-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0136
Number of participants with account balances2014-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0138
Total number of active participants reported on line 7a of the Form 55002013-01-010
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0136
Total of all active and inactive participants2013-01-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0136
Number of participants with account balances2013-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0143
Total number of active participants reported on line 7a of the Form 55002012-01-0126
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0112
Total of all active and inactive participants2012-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0138
Number of participants with account balances2012-01-0138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0144
Total number of active participants reported on line 7a of the Form 55002011-01-0129
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0114
Total of all active and inactive participants2011-01-0143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0143
Number of participants with account balances2011-01-0143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0156
Total number of active participants reported on line 7a of the Form 55002009-01-0132
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0117
Total of all active and inactive participants2009-01-0149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0149
Number of participants with account balances2009-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011

Financial Data on AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN

Measure Date Value
2017 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2017 401k financial data
Total income from all sources2017-12-31$2,861
Expenses. Total of all expenses incurred2017-12-31$552,910
Benefits paid (including direct rollovers)2017-12-31$543,857
Total plan assets at end of year2017-12-31$20,381
Total plan assets at beginning of year2017-12-31$570,430
Value of fidelity bond covering the plan2017-12-31$2,000,000
Expenses. Other expenses not covered elsewhere2017-12-31$9,053
Other income received2017-12-31$2,861
Net income (gross income less expenses)2017-12-31$-550,049
Net plan assets at end of year (total assets less liabilities)2017-12-31$20,381
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$570,430
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2016 401k financial data
Total income from all sources2016-12-31$-301,453
Expenses. Total of all expenses incurred2016-12-31$3,899
Total plan assets at end of year2016-12-31$570,430
Total plan assets at beginning of year2016-12-31$875,782
Value of fidelity bond covering the plan2016-12-31$2,430,000
Expenses. Other expenses not covered elsewhere2016-12-31$3,899
Other income received2016-12-31$-301,453
Net income (gross income less expenses)2016-12-31$-305,352
Net plan assets at end of year (total assets less liabilities)2016-12-31$570,430
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$875,782
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2015 401k financial data
Total income from all sources2015-12-31$-1,125,124
Expenses. Total of all expenses incurred2015-12-31$29,862
Total plan assets at end of year2015-12-31$875,782
Total plan assets at beginning of year2015-12-31$2,030,768
Value of fidelity bond covering the plan2015-12-31$2,430,000
Assets. Value of loans (other than to participants)2015-12-31$509,199
Other income received2015-12-31$-1,125,124
Net income (gross income less expenses)2015-12-31$-1,154,986
Net plan assets at end of year (total assets less liabilities)2015-12-31$875,782
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$2,030,768
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$29,862
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2014 401k financial data
Total income from all sources2014-12-31$5,800
Expenses. Total of all expenses incurred2014-12-31$567,365
Benefits paid (including direct rollovers)2014-12-31$567,365
Total plan assets at end of year2014-12-31$2,030,768
Total plan assets at beginning of year2014-12-31$2,592,333
Value of fidelity bond covering the plan2014-12-31$2,430,000
Assets. Value of loans (other than to participants)2014-12-31$925,817
Other income received2014-12-31$5,800
Net income (gross income less expenses)2014-12-31$-561,565
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,030,768
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$2,592,333
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$40,000
Total income from all sources2013-12-31$908,194
Expenses. Total of all expenses incurred2013-12-31$1,966,644
Benefits paid (including direct rollovers)2013-12-31$1,909,405
Total plan assets at end of year2013-12-31$2,592,333
Total plan assets at beginning of year2013-12-31$3,610,783
Value of fidelity bond covering the plan2013-12-31$1,000,000
Total contributions received or receivable from participants2013-12-31$53,227
Assets. Value of loans (other than to participants)2013-12-31$1,564,631
Other income received2013-12-31$772,467
Net income (gross income less expenses)2013-12-31$-1,058,450
Net plan assets at end of year (total assets less liabilities)2013-12-31$2,552,333
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$3,610,783
Assets. Value of employer securities2013-12-31$925,817
Total contributions received or receivable from employer(s)2013-12-31$82,500
Value of certain deemed distributions of participant loans2013-12-31$10,479
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$46,760
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2012 401k financial data
Total plan liabilities at beginning of year2012-12-31$98
Total income from all sources2012-12-31$543,779
Expenses. Total of all expenses incurred2012-12-31$297,263
Benefits paid (including direct rollovers)2012-12-31$297,248
Total plan assets at end of year2012-12-31$3,610,783
Total plan assets at beginning of year2012-12-31$3,364,365
Value of fidelity bond covering the plan2012-12-31$1,000,000
Total contributions received or receivable from participants2012-12-31$132,100
Other income received2012-12-31$182,623
Net income (gross income less expenses)2012-12-31$246,516
Net plan assets at end of year (total assets less liabilities)2012-12-31$3,610,783
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$3,364,267
Assets. Value of participant loans2012-12-31$12,728
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022012-12-31$659
Assets. Value of employer securities2012-12-31$1,952,397
Total contributions received or receivable from employer(s)2012-12-31$229,056
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$15
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$98
Total plan liabilities at beginning of year2011-12-31$57,100
Total income from all sources2011-12-31$158,111
Expenses. Total of all expenses incurred2011-12-31$193,501
Benefits paid (including direct rollovers)2011-12-31$193,431
Total plan assets at end of year2011-12-31$3,364,365
Total plan assets at beginning of year2011-12-31$3,456,757
Value of fidelity bond covering the plan2011-12-31$1,000,000
Total contributions received or receivable from participants2011-12-31$147,985
Other income received2011-12-31$-254,149
Net income (gross income less expenses)2011-12-31$-35,390
Net plan assets at end of year (total assets less liabilities)2011-12-31$3,364,267
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$3,399,657
Assets. Value of participant loans2011-12-31$39,403
Assets. Value of employer securities2011-12-31$1,864,236
Total contributions received or receivable from employer(s)2011-12-31$264,275
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$70
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$57,100
Total plan liabilities at beginning of year2010-12-31$98
Total income from all sources2010-12-31$554,953
Expenses. Total of all expenses incurred2010-12-31$423,930
Benefits paid (including direct rollovers)2010-12-31$423,896
Total plan assets at end of year2010-12-31$3,456,757
Total plan assets at beginning of year2010-12-31$3,268,732
Value of fidelity bond covering the plan2010-12-31$1,000,000
Total contributions received or receivable from participants2010-12-31$161,067
Expenses. Other expenses not covered elsewhere2010-12-31$34
Other income received2010-12-31$124,850
Net income (gross income less expenses)2010-12-31$131,023
Net plan assets at end of year (total assets less liabilities)2010-12-31$3,399,657
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$3,268,634
Assets. Value of employer securities2010-12-31$1,813,233
Total contributions received or receivable from employer(s)2010-12-31$269,036
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN

2017: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: AMERICAN ARIUM EMPLOYEES 401(K) STOCK OWNERSHIP PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan 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 number20218
Policy instance 1
Insurance contract or identification number20218
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,341
Total amount of fees paid to insurance companyUSD $1,002
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,341
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Insurance broker nameROCKY MOUNTAIN EMPL BENEFITS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number20218
Policy instance 1
Insurance contract or identification number20218
Number of Individuals Covered22
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,316
Total amount of fees paid to insurance companyUSD $772
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,316
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Insurance broker nameROCKY MOUNTAIN EMPL BENEFITS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number20218
Policy instance 1
Insurance contract or identification number20218
Number of Individuals Covered23
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $6,692
Total amount of fees paid to insurance companyUSD $839
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number20218
Policy instance 1
Insurance contract or identification number20218
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,878
Total amount of fees paid to insurance companyUSD $712
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $6,878
Insurance broker organization code?3
Amount paid for insurance broker fees712
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameROCKY MOUNTAIN EMPL BENEFITS, INC.

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