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WESTERN PACIFIC TILE INC. 401(K) PLAN 401k Plan overview

Plan NameWESTERN PACIFIC TILE INC. 401(K) PLAN
Plan identification number 001

WESTERN PACIFIC TILE INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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).
  • 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

WESTERN PACIFIC TILE INC. has sponsored the creation of one or more 401k plans.

Company Name:WESTERN PACIFIC TILE INC.
Employer identification number (EIN):274661866
NAIC Classification:442210
NAIC Description:Floor Covering Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTERN PACIFIC TILE INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01MARK ROBSON
0012016-01-01MARK ROBSON2017-10-10

Plan Statistics for WESTERN PACIFIC TILE INC. 401(K) PLAN

401k plan membership statisitcs for WESTERN PACIFIC TILE INC. 401(K) PLAN

Measure Date Value
2023: WESTERN PACIFIC TILE INC. 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-019
Total number of active participants reported on line 7a of the Form 55002023-01-017
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-012
Total of all active and inactive participants2023-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-010
Total participants2023-01-019
Number of participants with account balances2023-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-010
2022: WESTERN PACIFIC TILE INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0110
Total number of active participants reported on line 7a of the Form 55002022-01-019
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-019
Number of participants with account balances2022-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: WESTERN PACIFIC TILE INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-019
Total number of active participants reported on line 7a of the Form 55002021-01-019
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-011
Total of all active and inactive participants2021-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0110
Number of participants with account balances2021-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: WESTERN PACIFIC TILE INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-019
Total number of active participants reported on line 7a of the Form 55002020-01-019
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-019
Number of participants with account balances2020-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: WESTERN PACIFIC TILE INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-017
Total number of active participants reported on line 7a of the Form 55002019-01-019
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-019
Number of participants with account balances2019-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: WESTERN PACIFIC TILE INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-017
Total number of active participants reported on line 7a of the Form 55002018-01-017
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 participants2018-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-017
Number of participants with account balances2018-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: WESTERN PACIFIC TILE INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-017
Total number of active participants reported on line 7a of the Form 55002017-01-017
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-017
Number of participants with account balances2017-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010

Financial Data on WESTERN PACIFIC TILE INC. 401(K) PLAN

Measure Date Value
2023 : WESTERN PACIFIC TILE INC. 401(K) PLAN 2023 401k financial data
Total income from all sources2023-12-31$12,125
Expenses. Total of all expenses incurred2023-12-31$1,584
Total plan assets at end of year2023-12-31$78,099
Total plan assets at beginning of year2023-12-31$67,558
Value of fidelity bond covering the plan2023-12-31$20,000
Other income received2023-12-31$12,125
Net income (gross income less expenses)2023-12-31$10,541
Net plan assets at end of year (total assets less liabilities)2023-12-31$78,099
Net plan assets at beginning of year (total assets less liabilities)2023-12-31$67,558
Expenses. Administrative service providers (salaries,fees and commissions)2023-12-31$1,584
2022 : WESTERN PACIFIC TILE INC. 401(K) PLAN 2022 401k financial data
Total income from all sources2022-12-31$-13,627
Expenses. Total of all expenses incurred2022-12-31$47,314
Benefits paid (including direct rollovers)2022-12-31$45,751
Total plan assets at end of year2022-12-31$67,558
Total plan assets at beginning of year2022-12-31$128,499
Value of fidelity bond covering the plan2022-12-31$20,000
Other income received2022-12-31$-13,627
Net income (gross income less expenses)2022-12-31$-60,941
Net plan assets at end of year (total assets less liabilities)2022-12-31$67,558
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$128,499
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$1,563
2021 : WESTERN PACIFIC TILE INC. 401(K) PLAN 2021 401k financial data
Total income from all sources2021-12-31$26,575
Expenses. Total of all expenses incurred2021-12-31$1,304
Total plan assets at end of year2021-12-31$128,499
Total plan assets at beginning of year2021-12-31$103,228
Value of fidelity bond covering the plan2021-12-31$20,000
Total contributions received or receivable from participants2021-12-31$0
Other income received2021-12-31$7,553
Net income (gross income less expenses)2021-12-31$25,271
Net plan assets at end of year (total assets less liabilities)2021-12-31$128,499
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$103,228
Assets. Value of employer securities2021-12-31$36,020
Total contributions received or receivable from employer(s)2021-12-31$19,022
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$1,304
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : WESTERN PACIFIC TILE INC. 401(K) PLAN 2020 401k financial data
Total income from all sources2020-12-31$25,478
Expenses. Total of all expenses incurred2020-12-31$737
Total plan assets at end of year2020-12-31$103,228
Total plan assets at beginning of year2020-12-31$78,487
Value of fidelity bond covering the plan2020-12-31$10,000
Other income received2020-12-31$5,206
Net income (gross income less expenses)2020-12-31$24,741
Net plan assets at end of year (total assets less liabilities)2020-12-31$103,228
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$78,487
Assets. Value of employer securities2020-12-31$56,292
Total contributions received or receivable from employer(s)2020-12-31$20,272
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$737
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : WESTERN PACIFIC TILE INC. 401(K) PLAN 2019 401k financial data
Total income from all sources2019-12-31$24,606
Expenses. Total of all expenses incurred2019-12-31$572
Total plan assets at end of year2019-12-31$78,487
Total plan assets at beginning of year2019-12-31$54,453
Value of fidelity bond covering the plan2019-12-31$10,000
Other income received2019-12-31$4,334
Net income (gross income less expenses)2019-12-31$24,034
Net plan assets at end of year (total assets less liabilities)2019-12-31$78,487
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$54,453
Assets. Value of employer securities2019-12-31$36,020
Total contributions received or receivable from employer(s)2019-12-31$20,272
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$572
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : WESTERN PACIFIC TILE INC. 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$17,631
Expenses. Total of all expenses incurred2018-12-31$560
Total plan assets at end of year2018-12-31$54,453
Total plan assets at beginning of year2018-12-31$37,382
Value of fidelity bond covering the plan2018-12-31$10,000
Other income received2018-12-31$-1,307
Net income (gross income less expenses)2018-12-31$17,071
Net plan assets at end of year (total assets less liabilities)2018-12-31$54,453
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$37,382
Assets. Value of employer securities2018-12-31$36,020
Total contributions received or receivable from employer(s)2018-12-31$18,938
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$560
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : WESTERN PACIFIC TILE INC. 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$18,557
Expenses. Total of all expenses incurred2017-12-31$262
Total plan assets at end of year2017-12-31$37,382
Total plan assets at beginning of year2017-12-31$19,087
Total contributions received or receivable from participants2017-12-31$0
Other income received2017-12-31$1,475
Net income (gross income less expenses)2017-12-31$18,295
Net plan assets at end of year (total assets less liabilities)2017-12-31$37,382
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$19,087
Total contributions received or receivable from employer(s)2017-12-31$17,082
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$262
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0

Form 5500 Responses for WESTERN PACIFIC TILE INC. 401(K) PLAN

2023: WESTERN PACIFIC TILE INC. 401(K) PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2022: WESTERN PACIFIC TILE INC. 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: WESTERN PACIFIC TILE INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: WESTERN PACIFIC TILE INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: WESTERN PACIFIC TILE INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: WESTERN PACIFIC TILE INC. 401(K) 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 filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: WESTERN PACIFIC TILE INC. 401(K) 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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number125999
Policy instance 1
Insurance contract or identification number125999
Number of Individuals Covered7
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $359
Total amount of fees paid to insurance companyUSD $0
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number125999
Policy instance 1
Insurance contract or identification number125999
Number of Individuals Covered8
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,588
Total amount of fees paid to insurance companyUSD $0
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 $1,588
Amount paid for insurance broker fees0
Additional information about fees paid to insurance broker3
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number125999
Policy instance 1
Insurance contract or identification number125999
Number of Individuals Covered7
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $275
Total amount of fees paid to insurance companyUSD $0
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 $275
Amount paid for insurance broker fees0
Additional information about fees paid to insurance broker3
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number125999
Policy instance 1
Insurance contract or identification number125999
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $132
Total amount of fees paid to insurance companyUSD $0
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 $132
Amount paid for insurance broker fees0
Additional information about fees paid to insurance broker3
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number125999
Policy instance 1
Insurance contract or identification number125999
Number of Individuals Covered5
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $110
Total amount of fees paid to insurance companyUSD $0
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 $102
Amount paid for insurance broker fees0
Additional information about fees paid to insurance broker3
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number125999
Policy instance 1
Insurance contract or identification number125999
Number of Individuals Covered5
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $110
Total amount of fees paid to insurance companyUSD $0
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 $100
Amount paid for insurance broker fees0
Additional information about fees paid to insurance broker3
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number125999
Policy instance 1
Insurance contract or identification number125999
Number of Individuals Covered5
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $88
Total amount of fees paid to insurance companyUSD $0
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 $47
Amount paid for insurance broker fees0
Additional information about fees paid to insurance broker3
Insurance broker organization code?3
Insurance broker nameLINCOLN FINANCIAL SECURITIES

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