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ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 401k Plan overview

Plan NameADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN
Plan identification number 003

ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

ADVANCED DENTAL CARE, S.C. has sponsored the creation of one or more 401k plans.

Company Name:ADVANCED DENTAL CARE, S.C.
Employer identification number (EIN):010894924
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032018-01-01RIECK BEIERSDORF
0032017-01-01RIECK BEIERSDORF
0032016-01-01RIECK BEIERSDORF
0032015-01-01RIECK BEIERSDORF
0032014-01-01RIECK BEIERSDORF
0032013-01-01RIECK BEIERSDORF
0032012-01-01RIECK BEIERSDORF
0032011-01-01RIECK BEIERSDORF
0032009-01-01RIECK BEIERSDORF
0032009-01-01RIECK BEIERSDORF
0032009-01-01RIECK BEIERSDORF
0032009-01-01RIECK BEIERSDORF

Plan Statistics for ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN

401k plan membership statisitcs for ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN

Measure Date Value
2018: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-010
Number of participants with account balances2018-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-017
Total number of active participants reported on line 7a of the Form 55002017-01-011
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-018
Total of all active and inactive participants2017-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-019
Number of participants with account balances2017-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-018
Total number of active participants reported on line 7a of the Form 55002016-01-017
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-018
Number of participants with account balances2016-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-018
Total number of active participants reported on line 7a of the Form 55002015-01-018
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-018
Number of participants with account balances2015-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-018
Total number of active participants reported on line 7a of the Form 55002014-01-018
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-018
Number of participants with account balances2014-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-018
Total number of active participants reported on line 7a of the Form 55002013-01-018
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-018
Number of participants with account balances2013-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-018
Total number of active participants reported on line 7a of the Form 55002012-01-018
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-018
Number of participants with account balances2012-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-018
Total number of active participants reported on line 7a of the Form 55002011-01-018
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-018
Number of participants with account balances2011-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0110
Total number of active participants reported on line 7a of the Form 55002009-01-018
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-018
Number of participants with account balances2009-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN

Measure Date Value
2018 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2018 401k financial data
Total income from all sources2018-07-30$11,948
Expenses. Total of all expenses incurred2018-07-30$976,083
Benefits paid (including direct rollovers)2018-07-30$974,028
Total plan assets at end of year2018-07-30$0
Total plan assets at beginning of year2018-07-30$964,135
Value of fidelity bond covering the plan2018-07-30$105,000
Other income received2018-07-30$11,948
Net income (gross income less expenses)2018-07-30$-964,135
Net plan assets at end of year (total assets less liabilities)2018-07-30$0
Net plan assets at beginning of year (total assets less liabilities)2018-07-30$964,135
Expenses. Administrative service providers (salaries,fees and commissions)2018-07-30$2,055
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-07-30$0
2017 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2017 401k financial data
Total income from all sources2017-12-31$125,158
Expenses. Total of all expenses incurred2017-12-31$3,603
Total plan assets at end of year2017-12-31$964,135
Total plan assets at beginning of year2017-12-31$842,580
Value of fidelity bond covering the plan2017-12-31$105,000
Total contributions received or receivable from participants2017-12-31$6,590
Other income received2017-12-31$114,055
Net income (gross income less expenses)2017-12-31$121,555
Net plan assets at end of year (total assets less liabilities)2017-12-31$964,135
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$842,580
Total contributions received or receivable from employer(s)2017-12-31$4,513
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$3,603
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2016 401k financial data
Total income from all sources2016-12-31$95,799
Expenses. Total of all expenses incurred2016-12-31$3,246
Total plan assets at end of year2016-12-31$842,580
Total plan assets at beginning of year2016-12-31$750,027
Value of fidelity bond covering the plan2016-12-31$105,000
Total contributions received or receivable from participants2016-12-31$25,935
Other income received2016-12-31$59,520
Net income (gross income less expenses)2016-12-31$92,553
Net plan assets at end of year (total assets less liabilities)2016-12-31$842,580
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$750,027
Total contributions received or receivable from employer(s)2016-12-31$10,344
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$3,246
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2015 401k financial data
Total income from all sources2015-12-31$9,907
Expenses. Total of all expenses incurred2015-12-31$3,148
Total plan assets at end of year2015-12-31$750,027
Total plan assets at beginning of year2015-12-31$743,268
Value of fidelity bond covering the plan2015-12-31$100,000
Total contributions received or receivable from participants2015-12-31$25,135
Other income received2015-12-31$-26,160
Net income (gross income less expenses)2015-12-31$6,759
Net plan assets at end of year (total assets less liabilities)2015-12-31$750,027
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$743,268
Total contributions received or receivable from employer(s)2015-12-31$10,932
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$3,148
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2014 401k financial data
Total income from all sources2014-12-31$89,949
Expenses. Total of all expenses incurred2014-12-31$2,941
Total plan assets at end of year2014-12-31$743,268
Total plan assets at beginning of year2014-12-31$656,260
Value of fidelity bond covering the plan2014-12-31$100,000
Total contributions received or receivable from participants2014-12-31$24,243
Other income received2014-12-31$20,592
Net income (gross income less expenses)2014-12-31$87,008
Net plan assets at end of year (total assets less liabilities)2014-12-31$743,268
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$656,260
Total contributions received or receivable from employer(s)2014-12-31$45,114
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$2,941
2013 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2013 401k financial data
Total income from all sources2013-12-31$154,589
Expenses. Total of all expenses incurred2013-12-31$2,564
Total plan assets at end of year2013-12-31$656,260
Total plan assets at beginning of year2013-12-31$504,235
Value of fidelity bond covering the plan2013-12-31$100,000
Total contributions received or receivable from participants2013-12-31$24,082
Other income received2013-12-31$75,952
Net income (gross income less expenses)2013-12-31$152,025
Net plan assets at end of year (total assets less liabilities)2013-12-31$656,260
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$504,235
Total contributions received or receivable from employer(s)2013-12-31$54,555
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$2,564
2012 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2012 401k financial data
Total income from all sources2012-12-31$125,204
Expenses. Total of all expenses incurred2012-12-31$2,073
Total plan assets at end of year2012-12-31$504,235
Total plan assets at beginning of year2012-12-31$381,104
Value of fidelity bond covering the plan2012-12-31$100,000
Total contributions received or receivable from participants2012-12-31$22,728
Other income received2012-12-31$49,325
Net income (gross income less expenses)2012-12-31$123,131
Net plan assets at end of year (total assets less liabilities)2012-12-31$504,235
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$381,104
Total contributions received or receivable from employer(s)2012-12-31$53,151
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$2,073
2011 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2011 401k financial data
Total income from all sources2011-12-31$65,121
Expenses. Total of all expenses incurred2011-12-31$1,721
Total plan assets at end of year2011-12-31$381,104
Total plan assets at beginning of year2011-12-31$317,704
Value of fidelity bond covering the plan2011-12-31$100,000
Total contributions received or receivable from participants2011-12-31$21,770
Other income received2011-12-31$-9,142
Net income (gross income less expenses)2011-12-31$63,400
Net plan assets at end of year (total assets less liabilities)2011-12-31$381,104
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$317,704
Total contributions received or receivable from employer(s)2011-12-31$52,493
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$1,721
2010 : ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2010 401k financial data
Total income from all sources2010-12-31$102,413
Expenses. Total of all expenses incurred2010-12-31$1,322
Total plan assets at end of year2010-12-31$317,704
Total plan assets at beginning of year2010-12-31$216,613
Value of fidelity bond covering the plan2010-12-31$100,000
Total contributions received or receivable from participants2010-12-31$21,578
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$30,669
Net income (gross income less expenses)2010-12-31$101,091
Net plan assets at end of year (total assets less liabilities)2010-12-31$317,704
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$216,613
Total contributions received or receivable from employer(s)2010-12-31$50,166
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$1,322

Form 5500 Responses for ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN

2018: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingYes
2018-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K 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 – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K 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 – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K 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 – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K 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 – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
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: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K 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: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K 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: ADVANCED DENTAL CARE, S.C. SAFE HARBOR 401K PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
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 - 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 number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered0
Insurance policy start date2018-01-01
Insurance policy end date2018-07-30
Total amount of commissions paid to insurance brokerUSD $1,039
Total amount of fees paid to insurance companyUSD $688
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 $1,039
Insurance broker organization code?7
Amount paid for insurance broker fees688
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePPG RETIREMENT PLAN SERVICES, LTD.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered9
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,256
Total amount of fees paid to insurance companyUSD $452
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 $2,256
Insurance broker organization code?7
Amount paid for insurance broker fees452
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePPG RETIREMENT PLAN SERVICES, LTD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered8
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,900
Total amount of fees paid to insurance companyUSD $381
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?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 $1,900
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
Insurance broker namePPG RETIREMENT PLAN SERVICES, LTD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered8
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,724
Total amount of fees paid to insurance companyUSD $358
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?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 $1,724
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
Insurance broker namePPG RETIREMENT PLAN SERVICES, LTD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered8
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,367
Total amount of fees paid to insurance companyUSD $274
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?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 $1,367
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
Insurance broker namePPG RETIREMENT PLAN SERVICES, LTD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered8
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,054
Total amount of fees paid to insurance companyUSD $211
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?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 $1,054
Insurance broker organization code?7
Amount paid for insurance broker fees211
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePPG RETIREMENT PLAN SERVICES, LTD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered8
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $838
Total amount of fees paid to insurance companyUSD $166
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?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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number92510
Policy instance 1
Insurance contract or identification number92510
Number of Individuals Covered8
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $832
Total amount of fees paid to insurance companyUSD $574
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?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 $832
Insurance broker organization code?7
Amount paid for insurance broker fees574
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePPG RETIREMENT PLAN SERVICES, LTD

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