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FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameFAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN
Plan identification number 001

FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING 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.

401k Sponsoring company profile

FAMILY & INDUSTRIAL MEDICAL CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:FAMILY & INDUSTRIAL MEDICAL CENTER, INC.
Employer identification number (EIN):770531398
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01FRANK MAZZONE2024-10-02
0012022-01-01FRANK MAZZONE2023-08-15
0012021-01-01FRANK MAZZONE, M.D.2022-10-11
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01FRANK MAZZONE, M.D.
0012012-01-01FRANK MAZZONE, M.D.
0012011-01-01FRANK MAZZONE, M.D.
0012009-01-01DOUGLAS S. HENDRY

Plan Statistics for FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2017: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0128
Total number of active participants reported on line 7a of the Form 55002017-01-0117
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0110
Total of all active and inactive participants2017-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0127
Number of participants with account balances2017-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0125
Total number of active participants reported on line 7a of the Form 55002016-01-0115
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0113
Total of all active and inactive participants2016-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0128
Number of participants with account balances2016-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0123
Total number of active participants reported on line 7a of the Form 55002015-01-0120
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-015
Total of all active and inactive participants2015-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0125
Number of participants with account balances2015-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-013
2014: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0127
Total number of active participants reported on line 7a of the Form 55002014-01-0121
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 participants2014-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0123
Number of participants with account balances2014-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0127
Total number of active participants reported on line 7a of the Form 55002013-01-0124
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 participants2013-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0125
Number of participants with account balances2013-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0129
Total number of active participants reported on line 7a of the Form 55002012-01-0123
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0124
Number of participants with account balances2012-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0127
Total number of active participants reported on line 7a of the Form 55002011-01-0123
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-014
Total of all active and inactive participants2011-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0127
Number of participants with account balances2011-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-013
2009: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0128
Total number of active participants reported on line 7a of the Form 55002009-01-0117
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-014
Total of all active and inactive participants2009-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0121
Number of participants with account balances2009-01-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-012

Financial Data on FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2017 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$9
Total income from all sources2017-12-31$404,872
Expenses. Total of all expenses incurred2017-12-31$37,448
Benefits paid (including direct rollovers)2017-12-31$33,961
Total plan assets at end of year2017-12-31$2,253,612
Total plan assets at beginning of year2017-12-31$1,886,197
Value of fidelity bond covering the plan2017-12-31$200,000
Total contributions received or receivable from participants2017-12-31$66,084
Expenses. Other expenses not covered elsewhere2017-12-31$1,661
Other income received2017-12-31$316,805
Net income (gross income less expenses)2017-12-31$367,424
Net plan assets at end of year (total assets less liabilities)2017-12-31$2,253,612
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,886,188
Assets. Value of participant loans2017-12-31$138
Total contributions received or receivable from employer(s)2017-12-31$21,983
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$1,826
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$9
Total plan liabilities at beginning of year2016-12-31$9
Total income from all sources2016-12-31$263,556
Expenses. Total of all expenses incurred2016-12-31$16,042
Benefits paid (including direct rollovers)2016-12-31$11,696
Total plan assets at end of year2016-12-31$1,886,197
Total plan assets at beginning of year2016-12-31$1,638,683
Value of fidelity bond covering the plan2016-12-31$200,000
Total contributions received or receivable from participants2016-12-31$100,162
Other income received2016-12-31$127,619
Net income (gross income less expenses)2016-12-31$247,514
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,886,188
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,638,674
Assets. Value of participant loans2016-12-31$361
Total contributions received or receivable from employer(s)2016-12-31$35,775
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$4,346
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$9
Total plan liabilities at beginning of year2015-12-31$23
Total income from all sources2015-12-31$105,238
Expenses. Total of all expenses incurred2015-12-31$31,034
Benefits paid (including direct rollovers)2015-12-31$26,810
Total plan assets at end of year2015-12-31$1,638,683
Total plan assets at beginning of year2015-12-31$1,564,493
Value of fidelity bond covering the plan2015-12-31$125,000
Total contributions received or receivable from participants2015-12-31$91,795
Other income received2015-12-31$-21,983
Net income (gross income less expenses)2015-12-31$74,204
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,638,674
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,564,470
Assets. Value of participant loans2015-12-31$565
Total contributions received or receivable from employer(s)2015-12-31$35,426
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$4,224
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$23
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$204,691
Expenses. Total of all expenses incurred2014-12-31$447,438
Benefits paid (including direct rollovers)2014-12-31$443,128
Total plan assets at end of year2014-12-31$1,564,493
Total plan assets at beginning of year2014-12-31$1,807,217
Value of fidelity bond covering the plan2014-12-31$125,000
Total contributions received or receivable from participants2014-12-31$101,366
Expenses. Other expenses not covered elsewhere2014-12-31$4,310
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$65,749
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$-242,747
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,564,470
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,807,217
Assets. Value of participant loans2014-12-31$5,021
Total contributions received or receivable from employer(s)2014-12-31$37,576
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$0
2013 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
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$428,182
Expenses. Total of all expenses incurred2013-12-31$76,682
Benefits paid (including direct rollovers)2013-12-31$71,621
Total plan assets at end of year2013-12-31$1,807,217
Total plan assets at beginning of year2013-12-31$1,455,717
Value of fidelity bond covering the plan2013-12-31$125,000
Total contributions received or receivable from participants2013-12-31$121,893
Expenses. Other expenses not covered elsewhere2013-12-31$5,061
Contributions received from other sources (not participants or employers)2013-12-31$8,485
Other income received2013-12-31$255,810
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$351,500
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,807,217
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,455,717
Assets. Value of participant loans2013-12-31$30,661
Total contributions received or receivable from employer(s)2013-12-31$41,994
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
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$323,995
Expenses. Total of all expenses incurred2012-12-31$63,839
Benefits paid (including direct rollovers)2012-12-31$54,494
Total plan assets at end of year2012-12-31$1,455,717
Total plan assets at beginning of year2012-12-31$1,195,561
Value of fidelity bond covering the plan2012-12-31$125,000
Total contributions received or receivable from participants2012-12-31$101,194
Expenses. Other expenses not covered elsewhere2012-12-31$9,345
Contributions received from other sources (not participants or employers)2012-12-31$21,367
Other income received2012-12-31$165,056
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$260,156
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,455,717
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,195,561
Assets. Value of participant loans2012-12-31$35,505
Total contributions received or receivable from employer(s)2012-12-31$36,378
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$2,247
2011 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
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$145,595
Expenses. Total of all expenses incurred2011-12-31$60,280
Benefits paid (including direct rollovers)2011-12-31$42,313
Total plan assets at end of year2011-12-31$1,195,561
Total plan assets at beginning of year2011-12-31$1,110,246
Value of fidelity bond covering the plan2011-12-31$125,000
Total contributions received or receivable from participants2011-12-31$107,850
Expenses. Other expenses not covered elsewhere2011-12-31$17,967
Contributions received from other sources (not participants or employers)2011-12-31$29,621
Other income received2011-12-31$-31,331
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$85,315
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,195,561
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,110,246
Assets. Value of participant loans2011-12-31$45,132
Total contributions received or receivable from employer(s)2011-12-31$39,455
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$884
2010 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$34
Total income from all sources2010-12-31$251,787
Expenses. Total of all expenses incurred2010-12-31$180,170
Benefits paid (including direct rollovers)2010-12-31$164,904
Total plan assets at end of year2010-12-31$1,110,246
Total plan assets at beginning of year2010-12-31$1,038,663
Value of fidelity bond covering the plan2010-12-31$125,000
Total contributions received or receivable from participants2010-12-31$93,082
Expenses. Other expenses not covered elsewhere2010-12-31$15,266
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$128,085
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$71,617
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,110,246
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,038,629
Assets. Value of participant loans2010-12-31$30,920
Total contributions received or receivable from employer(s)2010-12-31$30,620
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$123,999
2009 : FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN

2017: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 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: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 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: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 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: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 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: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) 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 – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: FAMILY & INDUSTRIAL MEDICAL CENTER, INC. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
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 number55348
Policy instance 1
Insurance contract or identification number55348
Number of Individuals Covered25
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,583
Total amount of fees paid to insurance companyUSD $2,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,583
Insurance broker organization code?3
Amount paid for insurance broker fees2688
Insurance broker namePENSYS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number55348
Policy instance 1
Insurance contract or identification number55348
Number of Individuals Covered25
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $12,058
Total amount of fees paid to insurance companyUSD $138
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $12,058
Insurance broker organization code?3
Amount paid for insurance broker fees138
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker namePENSYS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number55348
Policy instance 1
Insurance contract or identification number55348
Number of Individuals Covered25
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $12,648
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 $12,648
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number55348
Policy instance 1
Insurance contract or identification number55348
Number of Individuals Covered28
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11,955
Total amount of fees paid to insurance companyUSD $600
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?Yes
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 $11,955
Insurance broker organization code?3
Amount paid for insurance broker fees600
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker nameSAN LUIS PENSION CONSULTANTS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number55348
Policy instance 1
Insurance contract or identification number55348
Number of Individuals Covered26
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,027
Total amount of fees paid to insurance companyUSD $350
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?Yes
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?Yes
Commission paid to Insurance BrokerUSD $11,027
Insurance broker organization code?3
Amount paid for insurance broker fees350
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker nameSAN LUIS PENSION CONSULTANTS, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number55348
Policy instance 1
Insurance contract or identification number55348
Number of Individuals Covered28
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
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?Yes
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?Yes
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number55348
Policy instance 1
Insurance contract or identification number55348
Number of Individuals Covered23
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $9,644
Total amount of fees paid to insurance companyUSD $501
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?Yes
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
Commission paid to Insurance BrokerUSD $9,644
Insurance broker organization code?3
Amount paid for insurance broker fees501
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker nameSAN LUIS PENSION CONSULTANTS, INC.

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