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SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 401k Plan overview

Plan NameSURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN
Plan identification number 001

SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING 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.
  • 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

SURGICAL ASSOCIATES, PC has sponsored the creation of one or more 401k plans.

Company Name:SURGICAL ASSOCIATES, PC
Employer identification number (EIN):581244775
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01T. KENT MCBRIDE2024-03-27
0012022-01-01T. KENT MCBRIDE2023-08-22
0012021-01-01T. KENT MCBRIDE2022-06-06
0012020-01-01T. KENT MCBRIDE2021-07-28
0012019-01-01T. KENT MCBRIDE2020-08-27
0012018-01-01T. KENT MCBRIDE2019-10-09
0012017-01-01
0012016-01-01T. KENT MCBRIDE
0012015-01-01T. KENT MCBRIDE
0012014-01-01LISA S. CROSS
0012013-01-01T. KENT MCBRIDE
0012012-01-01T. KENT MCBRIDE
0012011-01-01T. KENT MCBRIDE
0012010-01-01T. KENT MCBRIDE
0012009-01-01T. KENT MCBRIDE

Plan Statistics for SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN

401k plan membership statisitcs for SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN

Measure Date Value
2017: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0124
Total number of active participants reported on line 7a of the Form 55002017-01-0120
Number of retired or separated participants receiving benefits2017-01-013
Number of other retired or separated participants entitled to future benefits2017-01-013
Total of all active and inactive participants2017-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0126
Number of participants with account balances2017-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0129
Total number of active participants reported on line 7a of the Form 55002016-01-0116
Number of retired or separated participants receiving benefits2016-01-013
Number of other retired or separated participants entitled to future benefits2016-01-013
Total of all active and inactive participants2016-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0122
Number of participants with account balances2016-01-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0130
Total number of active participants reported on line 7a of the Form 55002015-01-0119
Number of retired or separated participants receiving benefits2015-01-014
Number of other retired or separated participants entitled to future benefits2015-01-015
Total of all active and inactive participants2015-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0128
Number of participants with account balances2015-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0129
Total number of active participants reported on line 7a of the Form 55002014-01-0118
Number of retired or separated participants receiving benefits2014-01-013
Number of other retired or separated participants entitled to future benefits2014-01-017
Total of all active and inactive participants2014-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0128
Number of participants with account balances2014-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0123
Total number of active participants reported on line 7a of the Form 55002013-01-0122
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 participants2013-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0122
Number of participants with account balances2013-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0123
Total number of active participants reported on line 7a of the Form 55002012-01-0122
Total of all active and inactive participants2012-01-0122
Total participants2012-01-0122
Number of participants with account balances2012-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-011
2011: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0122
Total number of active participants reported on line 7a of the Form 55002011-01-0123
Total of all active and inactive participants2011-01-0123
Total participants2011-01-0123
Number of participants with account balances2011-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2010: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0124
Total number of active participants reported on line 7a of the Form 55002010-01-0122
Total of all active and inactive participants2010-01-0122
Total participants2010-01-0122
Number of participants with account balances2010-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-013
2009: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0122
Total number of active participants reported on line 7a of the Form 55002009-01-0124
Total of all active and inactive participants2009-01-0124
Total participants2009-01-0124
Number of participants with account balances2009-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011

Financial Data on SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN

Measure Date Value
2017 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$5,096
Total plan liabilities at beginning of year2017-12-31$5,096
Total income from all sources2017-12-31$216,475
Expenses. Total of all expenses incurred2017-12-31$136
Total plan assets at end of year2017-12-31$1,471,367
Total plan assets at beginning of year2017-12-31$1,255,028
Value of fidelity bond covering the plan2017-12-31$135,000
Total contributions received or receivable from participants2017-12-31$46,722
Expenses. Other expenses not covered elsewhere2017-12-31$100
Other income received2017-12-31$142,975
Net income (gross income less expenses)2017-12-31$216,339
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,466,271
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,249,932
Assets. Value of participant loans2017-12-31$1,449
Total contributions received or receivable from employer(s)2017-12-31$26,778
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$36
2016 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$5,096
Total income from all sources2016-12-31$113,757
Expenses. Total of all expenses incurred2016-12-31$139,969
Benefits paid (including direct rollovers)2016-12-31$139,739
Total plan assets at end of year2016-12-31$1,255,028
Total plan assets at beginning of year2016-12-31$1,276,144
Value of fidelity bond covering the plan2016-12-31$350,000
Total contributions received or receivable from participants2016-12-31$37,769
Expenses. Other expenses not covered elsewhere2016-12-31$184
Other income received2016-12-31$52,205
Net income (gross income less expenses)2016-12-31$-26,212
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,249,932
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,276,144
Assets. Value of participant loans2016-12-31$1,869
Total contributions received or receivable from employer(s)2016-12-31$23,783
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$46
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$78,849
Expenses. Total of all expenses incurred2015-12-31$2,790,449
Benefits paid (including direct rollovers)2015-12-31$2,788,637
Total plan assets at end of year2015-12-31$1,276,144
Total plan assets at beginning of year2015-12-31$3,987,744
Value of fidelity bond covering the plan2015-12-31$350,000
Total contributions received or receivable from participants2015-12-31$53,989
Expenses. Other expenses not covered elsewhere2015-12-31$74
Other income received2015-12-31$-16,698
Net income (gross income less expenses)2015-12-31$-2,711,600
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,276,144
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$3,987,744
Assets. Value of participant loans2015-12-31$6,993
Total contributions received or receivable from employer(s)2015-12-31$41,558
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$1,738
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-12-31$2,897
Total income from all sources2014-12-31$267,786
Expenses. Total of all expenses incurred2014-12-31$39,213
Benefits paid (including direct rollovers)2014-12-31$28,756
Total plan assets at end of year2014-12-31$3,987,744
Total plan assets at beginning of year2014-12-31$3,762,068
Value of fidelity bond covering the plan2014-12-31$350,000
Total contributions received or receivable from participants2014-12-31$60,282
Contributions received from other sources (not participants or employers)2014-12-31$33,296
Other income received2014-12-31$130,562
Net income (gross income less expenses)2014-12-31$228,573
Net plan assets at end of year (total assets less liabilities)2014-12-31$3,987,744
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$3,759,171
Assets. Value of participant loans2014-12-31$12,720
Total contributions received or receivable from employer(s)2014-12-31$43,646
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$10,457
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$2,897
Total income from all sources2013-12-31$537,377
Expenses. Total of all expenses incurred2013-12-31$107,334
Benefits paid (including direct rollovers)2013-12-31$97,860
Total plan assets at end of year2013-12-31$3,762,068
Total plan assets at beginning of year2013-12-31$3,329,128
Value of fidelity bond covering the plan2013-12-31$350,000
Total contributions received or receivable from participants2013-12-31$74,891
Expenses. Other expenses not covered elsewhere2013-12-31$602
Other income received2013-12-31$406,933
Net income (gross income less expenses)2013-12-31$430,043
Net plan assets at end of year (total assets less liabilities)2013-12-31$3,759,171
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$3,329,128
Assets. Value of participant loans2013-12-31$20,048
Total contributions received or receivable from employer(s)2013-12-31$55,553
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$8,872
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$290
Total income from all sources2012-12-31$659,211
Expenses. Total of all expenses incurred2012-12-31$1,406,299
Benefits paid (including direct rollovers)2012-12-31$1,396,998
Total plan assets at end of year2012-12-31$3,329,418
Total plan assets at beginning of year2012-12-31$4,076,216
Value of fidelity bond covering the plan2012-12-31$350,000
Expenses. Other expenses not covered elsewhere2012-12-31$9,301
Other income received2012-12-31$342,175
Net income (gross income less expenses)2012-12-31$-747,088
Net plan assets at end of year (total assets less liabilities)2012-12-31$3,329,128
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$4,076,216
Assets. Value of participant loans2012-12-31$3,179
Total contributions received or receivable from employer(s)2012-12-31$317,036
2011 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$324,840
Expenses. Total of all expenses incurred2011-12-31$48,757
Benefits paid (including direct rollovers)2011-12-31$37,365
Total plan assets at end of year2011-12-31$4,076,216
Total plan assets at beginning of year2011-12-31$3,800,133
Value of fidelity bond covering the plan2011-12-31$350,000
Total contributions received or receivable from participants2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$8,809
Other income received2011-12-31$-9,180
Net income (gross income less expenses)2011-12-31$276,083
Net plan assets at end of year (total assets less liabilities)2011-12-31$4,076,216
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$3,800,133
Assets. Value of participant loans2011-12-31$5,989
Total contributions received or receivable from employer(s)2011-12-31$325,211
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$11,392
2010 : SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at beginning of year2010-12-31$3,065
Total income from all sources2010-12-31$585,311
Expenses. Total of all expenses incurred2010-12-31$65,356
Benefits paid (including direct rollovers)2010-12-31$50,166
Total plan assets at end of year2010-12-31$3,800,133
Total plan assets at beginning of year2010-12-31$3,283,243
Value of fidelity bond covering the plan2010-12-31$350,000
Other income received2010-12-31$263,391
Net income (gross income less expenses)2010-12-31$519,955
Net plan assets at end of year (total assets less liabilities)2010-12-31$3,800,133
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$3,280,178
Assets. Value of participant loans2010-12-31$12,060
Total contributions received or receivable from employer(s)2010-12-31$321,920
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$15,190

Form 5500 Responses for SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN

2017: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING 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: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING 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: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING 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: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING 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: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING 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 – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2010: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: SURGICAL ASSOCIATES PC 401(K) EMPLOYEE PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
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 number109046
Policy instance 1
Insurance contract or identification number109046
Number of Individuals Covered26
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,731
Total amount of fees paid to insurance companyUSD $725
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,731
Insurance broker organization code?4
Amount paid for insurance broker fees725
Additional information about fees paid to insurance brokerTPA FEES & COMPENSATION
Insurance broker nameR. BRUCE TANNER & ASSOCIATES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number109046
Policy instance 1
Insurance contract or identification number109046
Number of Individuals Covered24
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,221
Total amount of fees paid to insurance companyUSD $74
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,221
Insurance broker organization code?4
Amount paid for insurance broker fees74
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameR. BRUCE TANNER & ASSOCIATES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number109046
Policy instance 1
Insurance contract or identification number109046
Number of Individuals Covered20
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,940
Total amount of fees paid to insurance companyUSD $45
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,940
Insurance broker organization code?4
Amount paid for insurance broker fees45
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameR. BRUCE TANNER & ASSOCIATES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number109046
Policy instance 1
Insurance contract or identification number109046
Number of Individuals Covered21
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,463
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
Amount paid for insurance broker fees6678
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?4
Insurance broker nameR. BRUCE TANNER & ASSOCIATES, INC.

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