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CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 401k Plan overview

Plan NameCARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN
Plan identification number 001

CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA has sponsored the creation of one or more 401k plans.

Company Name:CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA
Employer identification number (EIN):953680411
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01SATINDER BHATIA, M.D.
0012013-01-01STEVEN W. TABAK, M.D.
0012012-01-01STEVEN W. TABAK, M.D.
0012011-01-01STEVEN W. TABAK, M.D.
0012010-01-01STEVEN W. TABAK, M.D.
0012009-01-01STEVEN W. TABAK, M.D.

Plan Statistics for CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN

401k plan membership statisitcs for CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN

Measure Date Value
2014: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0198
Total number of active participants reported on line 7a of the Form 55002014-01-0176
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0118
Total of all active and inactive participants2014-01-0194
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0194
Number of participants with account balances2014-01-0192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-015
2013: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0199
Total number of active participants reported on line 7a of the Form 55002013-01-0176
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0122
Total of all active and inactive participants2013-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0198
Number of participants with account balances2013-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01111
Total number of active participants reported on line 7a of the Form 55002012-01-0176
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0123
Total of all active and inactive participants2012-01-0199
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0199
Number of participants with account balances2012-01-0198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-014
2011: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01111
Total number of active participants reported on line 7a of the Form 55002011-01-0175
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0133
Total of all active and inactive participants2011-01-01108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01108
Number of participants with account balances2011-01-01107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-015
2010: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01101
Total number of active participants reported on line 7a of the Form 55002010-01-0175
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0130
Total of all active and inactive participants2010-01-01105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01105
Number of participants with account balances2010-01-01104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-012
2009: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01101
Total number of active participants reported on line 7a of the Form 55002009-01-0176
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0125
Total of all active and inactive participants2009-01-01101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01101
Number of participants with account balances2009-01-01100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-016

Financial Data on CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN

Measure Date Value
2014 : CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$2,198,503
Expenses. Total of all expenses incurred2014-12-31$5,178,650
Benefits paid (including direct rollovers)2014-12-31$5,142,724
Total plan assets at end of year2014-12-31$28,317,048
Total plan assets at beginning of year2014-12-31$31,297,195
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$356,782
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$15,605
Other income received2014-12-31$1,349,794
Net income (gross income less expenses)2014-12-31$-2,980,147
Net plan assets at end of year (total assets less liabilities)2014-12-31$28,317,048
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$31,297,195
Assets. Value of participant loans2014-12-31$6,066
Total contributions received or receivable from employer(s)2014-12-31$476,322
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$35,926
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING 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$6,933,547
Expenses. Total of all expenses incurred2013-12-31$1,441,647
Benefits paid (including direct rollovers)2013-12-31$1,394,986
Total plan assets at end of year2013-12-31$31,297,195
Total plan assets at beginning of year2013-12-31$25,805,295
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$339,998
Other income received2013-12-31$6,074,741
Net income (gross income less expenses)2013-12-31$5,491,900
Net plan assets at end of year (total assets less liabilities)2013-12-31$31,297,195
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$25,805,295
Assets. Value of participant loans2013-12-31$8,601
Assets. Value of assets in partnership/joint-venture interests2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$518,808
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$46,661
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING 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$3,118,432
Expenses. Total of all expenses incurred2012-12-31$780,089
Benefits paid (including direct rollovers)2012-12-31$739,117
Total plan assets at end of year2012-12-31$25,805,295
Total plan assets at beginning of year2012-12-31$23,466,952
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$297,439
Other income received2012-12-31$2,352,657
Net income (gross income less expenses)2012-12-31$2,338,343
Net plan assets at end of year (total assets less liabilities)2012-12-31$25,805,295
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$23,466,952
Assets. Value of participant loans2012-12-31$10,935
Assets. Value of assets in partnership/joint-venture interests2012-12-31$131,618
Total contributions received or receivable from employer(s)2012-12-31$468,336
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$40,972
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$500
Total income from all sources2011-12-31$1,164,690
Expenses. Total of all expenses incurred2011-12-31$1,217,090
Benefits paid (including direct rollovers)2011-12-31$1,178,302
Total plan assets at end of year2011-12-31$23,466,952
Total plan assets at beginning of year2011-12-31$23,519,852
Value of fidelity bond covering the plan2011-12-31$50,000
Total contributions received or receivable from participants2011-12-31$317,905
Other income received2011-12-31$378,190
Net income (gross income less expenses)2011-12-31$-52,400
Net plan assets at end of year (total assets less liabilities)2011-12-31$23,466,952
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$23,519,352
Assets. Value of participant loans2011-12-31$13,043
Assets. Value of assets in partnership/joint-venture interests2011-12-31$242,171
Total contributions received or receivable from employer(s)2011-12-31$468,595
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$38,788
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$500
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$3,085,408
Expenses. Total of all expenses incurred2010-12-31$752,342
Benefits paid (including direct rollovers)2010-12-31$717,025
Total plan assets at end of year2010-12-31$23,519,852
Total plan assets at beginning of year2010-12-31$21,186,286
Value of fidelity bond covering the plan2010-12-31$50,000
Total contributions received or receivable from participants2010-12-31$344,814
Other income received2010-12-31$2,253,202
Net income (gross income less expenses)2010-12-31$2,333,066
Net plan assets at end of year (total assets less liabilities)2010-12-31$23,519,352
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$21,186,286
Assets. Value of participant loans2010-12-31$14,953
Assets. Value of assets in partnership/joint-venture interests2010-12-31$273,276
Total contributions received or receivable from employer(s)2010-12-31$487,392
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$35,317
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K 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 CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN

2014: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K 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 - TrustYes
2012: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K 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 - TrustYes
2011: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K 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 - TrustYes
2010: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA 401K 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 - 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 number20022
Policy instance 1
Insurance contract or identification number20022
Number of Individuals Covered0
Insurance policy start date2014-01-01
Insurance policy end date2014-04-14
Total amount of commissions paid to insurance brokerUSD $11,714
Total amount of fees paid to insurance companyUSD $1,415
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,714
Insurance broker organization code?3
Amount paid for insurance broker fees1415
Additional information about fees paid to insurance brokerTPA FEES PAID AND TPA COMPENSATION
Insurance broker nameACTUARIAL BENEFITS CORP.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 61294-01
Policy instance 2
Insurance contract or identification numberMR 61294-01
Number of Individuals Covered92
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number20022
Policy instance 1
Insurance contract or identification number20022
Number of Individuals Covered83
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $45,008
Total amount of fees paid to insurance companyUSD $5,664
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,008
Insurance broker organization code?3
Amount paid for insurance broker fees5664
Additional information about fees paid to insurance brokerTPA FEES PAID, TPA COMPENSATION, TPA JH IRA R/O PMT,OTHER ALLOWANCE
Insurance broker nameACTUARIAL BENEFITS CORP.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number20022
Policy instance 1
Insurance contract or identification number20022
Number of Individuals Covered83
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $39,221
Total amount of fees paid to insurance companyUSD $5,200
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,221
Insurance broker organization code?3
Amount paid for insurance broker fees5200
Additional information about fees paid to insurance brokerTPA FEES PAID, TPA COMPENSATION, TPA JH IRA R/O PMT,OTHER ALLOWANCE
Insurance broker nameACTUARIAL BENEFITS CORP.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number20022
Policy instance 1
Insurance contract or identification number20022
Number of Individuals Covered90
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $37,834
Total amount of fees paid to insurance companyUSD $4,800
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number20022
Policy instance 1
Insurance contract or identification number20022
Number of Individuals Covered86
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $34,238
Total amount of fees paid to insurance companyUSD $3,915
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,238
Insurance broker organization code?3
Amount paid for insurance broker fees3915
Additional information about fees paid to insurance brokerTPA FEES PAID & TPA COMPENSATION
Insurance broker nameACTUARIAL BENEFITS CORP.

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