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S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 401k Plan overview

Plan NameS & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN
Plan identification number 001

S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 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.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

S&S WHOLESALE TIRE OF KNOXVILLE, INC. has sponsored the creation of one or more 401k plans.

Company Name:S&S WHOLESALE TIRE OF KNOXVILLE, INC.
Employer identification number (EIN):621314929
NAIC Classification:441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012020-01-01
0012019-01-01
0012018-01-01JERRY BROWNING2019-10-07
0012017-01-01JERRY BROWNING2018-08-22
0012016-01-01JERRY BROWNING2017-10-06
0012015-01-01JERRY BROWNING2016-09-30
0012014-01-01JERRY BROWNING2015-10-14
0012013-01-01JERRY BROWNING
0012012-01-01LANE COOPER
0012011-01-01LANE COOPER
0012010-01-01JERRY BROWNING
0012009-01-01JERRY BROWNING

Plan Statistics for S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN

401k plan membership statisitcs for S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN

Measure Date Value
2020: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01135
Total number of active participants reported on line 7a of the Form 55002020-01-010
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 participants2020-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-010
Number of participants with account balances2020-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01137
Total number of active participants reported on line 7a of the Form 55002019-01-01129
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-015
Total of all active and inactive participants2019-01-01135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01135
Number of participants with account balances2019-01-0160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2013: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0198
Total number of active participants reported on line 7a of the Form 55002013-01-0195
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-016
Total of all active and inactive participants2013-01-01101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01101
Number of participants with account balances2013-01-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01104
Total number of active participants reported on line 7a of the Form 55002012-01-0192
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-016
Total of all active and inactive participants2012-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0198
Number of participants with account balances2012-01-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0193
Total number of active participants reported on line 7a of the Form 55002011-01-0195
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-019
Total of all active and inactive participants2011-01-01104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01104
Number of participants with account balances2011-01-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0195
Total number of active participants reported on line 7a of the Form 55002010-01-0188
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-015
Total of all active and inactive participants2010-01-0193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0193
Number of participants with account balances2010-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0185
Total number of active participants reported on line 7a of the Form 55002009-01-0188
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-017
Total of all active and inactive participants2009-01-0195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0195
Number of participants with account balances2009-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN

Measure Date Value
2020 : S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets from this plan2020-12-31$6,281,628
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$6,281,628
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,396,836
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$2,043,352
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$2,041,642
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$400,020
Value of total assets at end of year2020-12-31$6,281,628
Value of total assets at beginning of year2020-12-31$6,928,144
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$1,710
Total interest from all sources2020-12-31$7,356
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2020-12-31$0
Administrative expenses professional fees incurred2020-12-31$1,350
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$277,031
Participant contributions at end of year2020-12-31$132,766
Participant contributions at beginning of year2020-12-31$127,297
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$6,281,628
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$122
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-646,516
Value of net assets at end of year (total assets less liabilities)2020-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$6,928,144
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in pooled separate accounts at end of year2020-12-31$6,148,862
Value of interest in pooled separate accounts at beginning of year2020-12-31$6,792,147
Interest on participant loans2020-12-31$7,356
Value of interest in common/collective trusts at end of year2020-12-31$0
Value of interest in common/collective trusts at beginning of year2020-12-31$8,578
Net investment gain/loss from pooled separate accounts2020-12-31$989,460
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$122,989
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$2,041,642
Contract administrator fees2020-12-31$360
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31Yes
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31TARWATER & COMPANY, P.C.
Accountancy firm EIN2020-12-31562397000
2019 : S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,500,422
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$528,451
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$526,419
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$367,095
Value of total assets at end of year2019-12-31$6,928,144
Value of total assets at beginning of year2019-12-31$5,956,173
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$2,032
Total interest from all sources2019-12-31$10,132
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$1,600
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$250,037
Participant contributions at end of year2019-12-31$127,297
Participant contributions at beginning of year2019-12-31$174,510
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$122
Total non interest bearing cash at beginning of year2019-12-31$114
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$971,971
Value of net assets at end of year (total assets less liabilities)2019-12-31$6,928,144
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$5,956,173
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$6,792,147
Value of interest in pooled separate accounts at beginning of year2019-12-31$5,773,549
Interest on participant loans2019-12-31$10,132
Interest earned on other investments2019-12-31$0
Value of interest in common/collective trusts at end of year2019-12-31$8,578
Value of interest in common/collective trusts at beginning of year2019-12-31$8,000
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$1,123,195
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$117,058
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$526,419
Contract administrator fees2019-12-31$432
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31TARWATER & COMPANY, P.C.
Accountancy firm EIN2019-12-31562397000
2013 : S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$883,063
Expenses. Total of all expenses incurred2013-12-31$192,885
Benefits paid (including direct rollovers)2013-12-31$189,478
Total plan assets at end of year2013-12-31$4,044,498
Total plan assets at beginning of year2013-12-31$3,354,320
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$212,842
Other income received2013-12-31$569,555
Net income (gross income less expenses)2013-12-31$690,178
Net plan assets at end of year (total assets less liabilities)2013-12-31$4,044,498
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$3,354,320
Assets. Value of participant loans2013-12-31$52,294
Total contributions received or receivable from employer(s)2013-12-31$100,666
Value of corrective distributions2013-12-31$3,407
2012 : S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$977,781
Expenses. Total of all expenses incurred2012-12-31$54,838
Benefits paid (including direct rollovers)2012-12-31$50,489
Total plan assets at end of year2012-12-31$3,354,320
Total plan assets at beginning of year2012-12-31$2,431,377
Value of fidelity bond covering the plan2012-12-31$400,000
Total contributions received or receivable from participants2012-12-31$203,400
Contributions received from other sources (not participants or employers)2012-12-31$322,918
Other income received2012-12-31$356,948
Net income (gross income less expenses)2012-12-31$922,943
Net plan assets at end of year (total assets less liabilities)2012-12-31$3,354,320
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$2,431,377
Assets. Value of participant loans2012-12-31$37,404
Total contributions received or receivable from employer(s)2012-12-31$94,515
Value of corrective distributions2012-12-31$4,349
2011 : S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$238,771
Expenses. Total of all expenses incurred2011-12-31$13,688
Benefits paid (including direct rollovers)2011-12-31$13,609
Total plan assets at end of year2011-12-31$2,431,377
Total plan assets at beginning of year2011-12-31$2,206,294
Value of fidelity bond covering the plan2011-12-31$250,000
Total contributions received or receivable from participants2011-12-31$215,071
Expenses. Other expenses not covered elsewhere2011-12-31$79
Other income received2011-12-31$-72,252
Net income (gross income less expenses)2011-12-31$225,083
Net plan assets at end of year (total assets less liabilities)2011-12-31$2,431,377
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$2,206,294
Assets. Value of participant loans2011-12-31$27,500
Total contributions received or receivable from employer(s)2011-12-31$95,952
2010 : S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$538,480
Expenses. Total of all expenses incurred2010-12-31$34,103
Benefits paid (including direct rollovers)2010-12-31$34,103
Total plan assets at end of year2010-12-31$2,206,294
Total plan assets at beginning of year2010-12-31$1,701,917
Value of fidelity bond covering the plan2010-12-31$250,000
Total contributions received or receivable from participants2010-12-31$200,992
Other income received2010-12-31$247,489
Net income (gross income less expenses)2010-12-31$504,377
Net plan assets at end of year (total assets less liabilities)2010-12-31$2,206,294
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,701,917
Assets. Value of participant loans2010-12-31$28,565
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022010-12-31$16,237
Total contributions received or receivable from employer(s)2010-12-31$89,999

Form 5500 Responses for S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN

2020: S & S WHOLESALE TIRE OF KNOXVILLE, 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 filingYes
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: S & S WHOLESALE TIRE OF KNOXVILLE, 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
2013: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 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 - TrustYes
2012: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 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 - TrustYes
2011: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 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 - TrustYes
2010: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 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 - TrustYes
2009: S & S WHOLESALE TIRE OF KNOXVILLE, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
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 number48789
Policy instance 1
Insurance contract or identification number48789
Number of Individuals Covered59
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $18,233
Total amount of fees paid to insurance companyUSD $3,288
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 $18,233
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number48789
Policy instance 1
Insurance contract or identification number48789
Number of Individuals Covered58
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $17,741
Total amount of fees paid to insurance companyUSD $3,284
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 $17,741
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number48789
Policy instance 1
Insurance contract or identification number48789
Number of Individuals Covered51
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,370
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
Commission paid to Insurance BrokerUSD $10,370
Insurance broker organization code?3
Amount paid for insurance broker fees0
Insurance broker nameFINANCIAL SERVICE ASSOCIATES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number65838
Policy instance 1
Insurance contract or identification number65838
Number of Individuals Covered53
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $8,768
Total amount of fees paid to insurance companyUSD $100
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 $8,768
Insurance broker organization code?3
Amount paid for insurance broker fees100
Additional information about fees paid to insurance brokerRECORDKEEPING
Insurance broker nameFINANCIAL SERVICE ASSOCIATES, INC.
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 Covered55
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,089
Total amount of fees paid to insurance companyUSD $1,302
Are there contracts with allocated funds for group deferred annuity?Yes
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 number48789
Policy instance 1
Insurance contract or identification number48789
Number of Individuals Covered55
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,057
Total amount of fees paid to insurance companyUSD $660
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

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