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PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NamePEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST
Plan identification number 001

PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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

PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C. has sponsored the creation of one or more 401k plans.

Company Name:PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C.
Employer identification number (EIN):581909763
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01LORI DESOUTTER2024-07-19
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01WILTON SANDERS2019-10-15 WILTON SANDERS2019-10-15
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01
0012012-01-01JULIAN GORVY
0012011-01-01LORI DESOUTTER MD
0012010-01-01LORI DESOUTTER MD
0012009-01-01LORI DESOUTTER MD

Plan Statistics for PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST

Measure Date Value
2018: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-0112
Total number of active participants reported on line 7a of the Form 55002018-01-019
Number of other retired or separated participants entitled to future benefits2018-01-016
Total of all active and inactive participants2018-01-0115
Total participants2018-01-0115
Number of participants with account balances2018-01-0112
2017: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-0116
Total number of active participants reported on line 7a of the Form 55002017-01-0112
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-012
Total of all active and inactive participants2017-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0114
Number of participants with account balances2017-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-0116
Total number of active participants reported on line 7a of the Form 55002016-01-0111
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-013
Total of all active and inactive participants2016-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0114
Number of participants with account balances2016-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-0114
Total number of active participants reported on line 7a of the Form 55002015-01-0111
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-012
Total of all active and inactive participants2015-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0113
Number of participants with account balances2015-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0115
Total number of active participants reported on line 7a of the Form 55002014-01-0112
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-012
Total of all active and inactive participants2014-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0114
Number of participants with account balances2014-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-011
2013: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0114
Total number of active participants reported on line 7a of the Form 55002013-01-0113
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0114
Number of participants with account balances2013-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-0112
Total number of active participants reported on line 7a of the Form 55002012-01-0112
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0113
Number of participants with account balances2012-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0114
Total number of active participants reported on line 7a of the Form 55002011-01-0111
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 participants2011-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0111
Number of participants with account balances2011-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-0116
Total number of active participants reported on line 7a of the Form 55002010-01-0111
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-012
Total of all active and inactive participants2010-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0113
Number of participants with account balances2010-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0116
Total number of active participants reported on line 7a of the Form 55002009-01-0113
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-013
Total of all active and inactive participants2009-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0116
Number of participants with account balances2009-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST

Measure Date Value
2018 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2018 401k financial data
Total income from all sources2018-12-31$8,929
Expenses. Total of all expenses incurred2018-12-31$130,064
Benefits paid (including direct rollovers)2018-12-31$130,000
Total plan assets at end of year2018-12-31$1,998,854
Total plan assets at beginning of year2018-12-31$2,119,989
Value of fidelity bond covering the plan2018-12-31$125,000
Total contributions received or receivable from participants2018-12-31$110,398
Other income received2018-12-31$-147,844
Net income (gross income less expenses)2018-12-31$-121,135
Net plan assets at end of year (total assets less liabilities)2018-12-31$1,998,854
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$2,119,989
Assets. Value of participant loans2018-12-31$884
Total contributions received or receivable from employer(s)2018-12-31$46,375
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$64
2017 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total income from all sources2017-12-31$443,333
Expenses. Total of all expenses incurred2017-12-31$58,181
Benefits paid (including direct rollovers)2017-12-31$58,079
Total plan assets at end of year2017-12-31$2,119,989
Total plan assets at beginning of year2017-12-31$1,734,837
Value of fidelity bond covering the plan2017-12-31$125,000
Total contributions received or receivable from participants2017-12-31$103,621
Other income received2017-12-31$295,231
Net income (gross income less expenses)2017-12-31$385,152
Net plan assets at end of year (total assets less liabilities)2017-12-31$2,119,989
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,734,837
Assets. Value of participant loans2017-12-31$2,097
Total contributions received or receivable from employer(s)2017-12-31$44,481
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$102
2016 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2016 401k financial data
Total income from all sources2016-12-31$230,472
Expenses. Total of all expenses incurred2016-12-31$3,585
Benefits paid (including direct rollovers)2016-12-31$3,435
Total plan assets at end of year2016-12-31$1,734,837
Total plan assets at beginning of year2016-12-31$1,507,950
Value of fidelity bond covering the plan2016-12-31$125,000
Total contributions received or receivable from participants2016-12-31$73,596
Other income received2016-12-31$121,326
Net income (gross income less expenses)2016-12-31$226,887
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,734,837
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,507,950
Assets. Value of participant loans2016-12-31$3,759
Total contributions received or receivable from employer(s)2016-12-31$35,550
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$150
2015 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-12-31$83,425
Expenses. Total of all expenses incurred2015-12-31$4,134
Benefits paid (including direct rollovers)2015-12-31$3,970
Total plan assets at end of year2015-12-31$1,507,950
Total plan assets at beginning of year2015-12-31$1,428,659
Value of fidelity bond covering the plan2015-12-31$125,000
Total contributions received or receivable from participants2015-12-31$67,614
Other income received2015-12-31$-19,109
Net income (gross income less expenses)2015-12-31$79,291
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,507,950
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,428,659
Assets. Value of participant loans2015-12-31$5,433
Total contributions received or receivable from employer(s)2015-12-31$34,920
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$164
2014 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-12-31$157,739
Expenses. Total of all expenses incurred2014-12-31$68,617
Benefits paid (including direct rollovers)2014-12-31$68,457
Total plan assets at end of year2014-12-31$1,428,659
Total plan assets at beginning of year2014-12-31$1,339,537
Value of fidelity bond covering the plan2014-12-31$125,000
Total contributions received or receivable from participants2014-12-31$66,708
Other income received2014-12-31$56,052
Net income (gross income less expenses)2014-12-31$89,122
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,428,659
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,339,537
Total contributions received or receivable from employer(s)2014-12-31$34,979
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$160
2013 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total income from all sources2013-12-31$284,032
Expenses. Total of all expenses incurred2013-12-31$122
Total plan assets at end of year2013-12-31$1,339,537
Total plan assets at beginning of year2013-12-31$1,055,627
Value of fidelity bond covering the plan2013-12-31$130,000
Total contributions received or receivable from participants2013-12-31$62,141
Other income received2013-12-31$194,676
Net income (gross income less expenses)2013-12-31$283,910
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,339,537
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,055,627
Total contributions received or receivable from employer(s)2013-12-31$27,215
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$122
2012 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Total income from all sources2012-12-31$215,007
Expenses. Total of all expenses incurred2012-12-31$2,881
Benefits paid (including direct rollovers)2012-12-31$31
Total plan assets at end of year2012-12-31$1,055,627
Total plan assets at beginning of year2012-12-31$843,501
Value of fidelity bond covering the plan2012-12-31$125,000
Total contributions received or receivable from participants2012-12-31$61,554
Other income received2012-12-31$120,705
Net income (gross income less expenses)2012-12-31$212,126
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,055,627
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$843,501
Total contributions received or receivable from employer(s)2012-12-31$32,748
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$2,850
2011 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Total income from all sources2011-12-31$128,384
Expenses. Total of all expenses incurred2011-12-31$259,114
Benefits paid (including direct rollovers)2011-12-31$255,353
Total plan assets at end of year2011-12-31$843,501
Total plan assets at beginning of year2011-12-31$974,231
Value of fidelity bond covering the plan2011-12-31$125,000
Total contributions received or receivable from participants2011-12-31$58,181
Other income received2011-12-31$40,934
Net income (gross income less expenses)2011-12-31$-130,730
Net plan assets at end of year (total assets less liabilities)2011-12-31$843,501
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$974,231
Total contributions received or receivable from employer(s)2011-12-31$29,269
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$3,761
2010 : PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Total income from all sources2010-12-31$365,012
Expenses. Total of all expenses incurred2010-12-31$1,610,976
Benefits paid (including direct rollovers)2010-12-31$1,610,910
Total plan assets at end of year2010-12-31$974,231
Total plan assets at beginning of year2010-12-31$2,220,195
Value of fidelity bond covering the plan2010-12-31$125,000
Total contributions received or receivable from participants2010-12-31$62,102
Other income received2010-12-31$275,396
Net income (gross income less expenses)2010-12-31$-1,245,964
Net plan assets at end of year (total assets less liabilities)2010-12-31$974,231
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$2,220,195
Total contributions received or receivable from employer(s)2010-12-31$27,514
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$66

Form 5500 Responses for PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST

2018: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 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: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
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: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
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: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: PEDIATRIC ASSOCIATES OF NORTH ATLANTA, P.C., PROFIT SHARING PLAN AND TRUST 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 number
Policy instance 1
Number of Individuals Covered12
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 number83366
Policy instance 1
Insurance contract or identification number83366
Number of Individuals Covered12
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
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 number83366
Policy instance 1
Insurance contract or identification number83366
Number of Individuals Covered11
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
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 number83366
Policy instance 1
Insurance contract or identification number83366
Number of Individuals Covered11
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 guaranteed investment?Yes
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 number83366
Policy instance 1
Insurance contract or identification number83366
Number of Individuals Covered11
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 $0
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 guaranteed investment?Yes
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 number83366
Policy instance 1
Insurance contract or identification number83366
Number of Individuals Covered10
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,358
Total amount of fees paid to insurance companyUSD $0
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 guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,358
Insurance broker nameTRIAD ADVISORS INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number83366
Policy instance 1
Insurance contract or identification number83366
Number of Individuals Covered10
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,589
Total amount of fees paid to insurance companyUSD $0
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 guaranteed investment?Yes
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 number83366
Policy instance 1
Insurance contract or identification number83366
Number of Individuals Covered10
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,978
Total amount of fees paid to insurance companyUSD $0
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 guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,978
Insurance broker nameTRIAD ADVISORS INC.

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