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NELSON PAN, D.D.S. RETIREMENT TRUST 401k Plan overview

Plan NameNELSON PAN, D.D.S. RETIREMENT TRUST
Plan identification number 001

NELSON PAN, D.D.S. RETIREMENT TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • 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

NELSON PAN, D.D.S. has sponsored the creation of one or more 401k plans.

Company Name:NELSON PAN, D.D.S.
Employer identification number (EIN):043058365
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NELSON PAN, D.D.S. RETIREMENT TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01NELSON PAN2024-06-27
0012022-01-01NELSON PAN2023-05-30
0012021-01-01NELSON PAN2022-05-18
0012020-01-01NELSON PAN, D.D.S.2021-10-14
0012019-01-01NELSON PAN, D.D.S.2020-10-08
0012018-01-01NELSON PAN, D.D.S.2019-10-08
0012017-01-01NELSON PAN, DDS
0012016-01-01NELSON PAN, DDS
0012015-01-01NELSON PAN, DDS
0012014-01-01NELSON PAN, DDS
0012013-01-01NELSON PAN, DDS
0012012-01-01NELSON PAN, DDS
0012011-01-01NELSON PAN, DDS
0012009-01-01NELSON PAN, DDS

Plan Statistics for NELSON PAN, D.D.S. RETIREMENT TRUST

401k plan membership statisitcs for NELSON PAN, D.D.S. RETIREMENT TRUST

Measure Date Value
2017: NELSON PAN, D.D.S. RETIREMENT TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-0116
Total number of active participants reported on line 7a of the Form 55002017-01-019
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-017
Total of all active and inactive participants2017-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0116
Number of participants with account balances2017-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: NELSON PAN, D.D.S. RETIREMENT TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-0115
Total number of active participants reported on line 7a of the Form 55002016-01-0110
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-016
Total of all active and inactive participants2016-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0116
Number of participants with account balances2016-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: NELSON PAN, D.D.S. RETIREMENT TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-0114
Total number of active participants reported on line 7a of the Form 55002015-01-018
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-016
Total of all active and inactive participants2015-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0114
Number of participants with account balances2015-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: NELSON PAN, D.D.S. RETIREMENT TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0114
Total number of active participants reported on line 7a of the Form 55002014-01-019
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-015
Total of all active and inactive participants2014-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0114
Number of participants with account balances2014-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: NELSON PAN, D.D.S. RETIREMENT TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0114
Total number of active participants reported on line 7a of the Form 55002013-01-019
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-015
Total of all active and inactive participants2013-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0114
Number of participants with account balances2013-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: NELSON PAN, D.D.S. RETIREMENT TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-0114
Total number of active participants reported on line 7a of the Form 55002012-01-019
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-015
Total of all active and inactive participants2012-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0114
Number of participants with account balances2012-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: NELSON PAN, D.D.S. RETIREMENT TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0114
Total number of active participants reported on line 7a of the Form 55002011-01-0110
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 participants2011-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0114
Number of participants with account balances2011-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: NELSON PAN, D.D.S. RETIREMENT TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0114
Total number of active participants reported on line 7a of the Form 55002009-01-0111
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-013
Total of all active and inactive participants2009-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0114
Number of participants with account balances2009-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on NELSON PAN, D.D.S. RETIREMENT TRUST

Measure Date Value
2017 : NELSON PAN, D.D.S. RETIREMENT TRUST 2017 401k financial data
Total income from all sources2017-12-31$247,776
Expenses. Total of all expenses incurred2017-12-31$69,088
Benefits paid (including direct rollovers)2017-12-31$69,043
Total plan assets at end of year2017-12-31$1,389,040
Total plan assets at beginning of year2017-12-31$1,210,352
Value of fidelity bond covering the plan2017-12-31$122,000
Total contributions received or receivable from participants2017-12-31$29,720
Other income received2017-12-31$200,839
Net income (gross income less expenses)2017-12-31$178,688
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,389,040
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,210,352
Assets. Value of participant loans2017-12-31$5,574
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022017-12-31$34,426
Total contributions received or receivable from employer(s)2017-12-31$17,217
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$45
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : NELSON PAN, D.D.S. RETIREMENT TRUST 2016 401k financial data
Total income from all sources2016-12-31$147,237
Expenses. Total of all expenses incurred2016-12-31$0
Total plan assets at end of year2016-12-31$1,210,352
Total plan assets at beginning of year2016-12-31$1,063,115
Value of fidelity bond covering the plan2016-12-31$25,000
Total contributions received or receivable from participants2016-12-31$26,394
Other income received2016-12-31$103,623
Net income (gross income less expenses)2016-12-31$147,237
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,210,352
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,063,115
Assets. Value of participant loans2016-12-31$1,903
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022016-12-31$20,607
Total contributions received or receivable from employer(s)2016-12-31$17,220
2015 : NELSON PAN, D.D.S. RETIREMENT TRUST 2015 401k financial data
Total income from all sources2015-12-31$-11,474
Expenses. Total of all expenses incurred2015-12-31$0
Total plan assets at end of year2015-12-31$1,063,115
Total plan assets at beginning of year2015-12-31$1,074,589
Value of fidelity bond covering the plan2015-12-31$25,000
Total contributions received or receivable from participants2015-12-31$24,513
Other income received2015-12-31$-50,609
Net income (gross income less expenses)2015-12-31$-11,474
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,063,115
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,074,589
Assets. Value of participant loans2015-12-31$6,654
Total contributions received or receivable from employer(s)2015-12-31$14,622
2014 : NELSON PAN, D.D.S. RETIREMENT TRUST 2014 401k financial data
Total income from all sources2014-12-31$71,663
Expenses. Total of all expenses incurred2014-12-31$0
Total plan assets at end of year2014-12-31$1,074,589
Total plan assets at beginning of year2014-12-31$1,002,926
Value of fidelity bond covering the plan2014-12-31$25,000
Total contributions received or receivable from participants2014-12-31$24,441
Other income received2014-12-31$32,574
Net income (gross income less expenses)2014-12-31$71,663
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,074,589
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,002,926
Assets. Value of participant loans2014-12-31$12,765
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022014-12-31$17,882
Total contributions received or receivable from employer(s)2014-12-31$14,648
2013 : NELSON PAN, D.D.S. RETIREMENT TRUST 2013 401k financial data
Total income from all sources2013-12-31$192,415
Expenses. Total of all expenses incurred2013-12-31$0
Total plan assets at end of year2013-12-31$1,002,926
Total plan assets at beginning of year2013-12-31$810,511
Value of fidelity bond covering the plan2013-12-31$25,000
Total contributions received or receivable from participants2013-12-31$24,926
Other income received2013-12-31$152,431
Net income (gross income less expenses)2013-12-31$192,415
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,002,926
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$810,511
Assets. Value of participant loans2013-12-31$34,617
Total contributions received or receivable from employer(s)2013-12-31$15,058
2012 : NELSON PAN, D.D.S. RETIREMENT TRUST 2012 401k financial data
Total income from all sources2012-12-31$129,150
Expenses. Total of all expenses incurred2012-12-31$0
Total plan assets at end of year2012-12-31$810,511
Total plan assets at beginning of year2012-12-31$681,361
Total contributions received or receivable from participants2012-12-31$23,037
Other income received2012-12-31$90,249
Net income (gross income less expenses)2012-12-31$129,150
Net plan assets at end of year (total assets less liabilities)2012-12-31$810,511
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$681,361
Assets. Value of participant loans2012-12-31$50,611
Total contributions received or receivable from employer(s)2012-12-31$15,864
2011 : NELSON PAN, D.D.S. RETIREMENT TRUST 2011 401k financial data
Total income from all sources2011-12-31$2,413
Expenses. Total of all expenses incurred2011-12-31$0
Total plan assets at end of year2011-12-31$681,361
Total plan assets at beginning of year2011-12-31$678,948
Value of fidelity bond covering the plan2011-12-31$25,000
Total contributions received or receivable from participants2011-12-31$21,251
Other income received2011-12-31$-34,335
Net income (gross income less expenses)2011-12-31$2,413
Net plan assets at end of year (total assets less liabilities)2011-12-31$681,361
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$678,948
Assets. Value of participant loans2011-12-31$49,579
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022011-12-31$6,571
Total contributions received or receivable from employer(s)2011-12-31$15,497
2010 : NELSON PAN, D.D.S. RETIREMENT TRUST 2010 401k financial data
Total income from all sources2010-12-31$130,729
Expenses. Total of all expenses incurred2010-12-31$5,227
Total plan assets at end of year2010-12-31$678,948
Total plan assets at beginning of year2010-12-31$553,446
Value of fidelity bond covering the plan2010-12-31$55,000
Total contributions received or receivable from participants2010-12-31$32,496
Other income received2010-12-31$75,410
Net income (gross income less expenses)2010-12-31$125,502
Net plan assets at end of year (total assets less liabilities)2010-12-31$678,948
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$553,446
Assets. Value of participant loans2010-12-31$9,398
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$888
Total contributions received or receivable from employer(s)2010-12-31$22,823
Value of corrective distributions2010-12-31$5,227
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : NELSON PAN, D.D.S. RETIREMENT TRUST 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 NELSON PAN, D.D.S. RETIREMENT TRUST

2017: NELSON PAN, D.D.S. RETIREMENT TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: NELSON PAN, D.D.S. RETIREMENT TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: NELSON PAN, D.D.S. RETIREMENT TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: NELSON PAN, D.D.S. RETIREMENT TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: NELSON PAN, D.D.S. RETIREMENT TRUST 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: NELSON PAN, D.D.S. RETIREMENT TRUST 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: NELSON PAN, D.D.S. RETIREMENT TRUST 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: NELSON PAN, D.D.S. RETIREMENT TRUST 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 number68305
Policy instance 1
Insurance contract or identification number68305
Number of Individuals Covered16
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,076
Total amount of fees paid to insurance companyUSD $762
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?Yes
Commission paid to Insurance BrokerUSD $5,076
Insurance broker organization code?3
Amount paid for insurance broker fees637
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameSWERDLIN NORTHEAST LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number68305
Policy instance 1
Insurance contract or identification number68305
Number of Individuals Covered15
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,234
Total amount of fees paid to insurance companyUSD $537
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,234
Insurance broker organization code?3
Amount paid for insurance broker fees537
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameSWERDLIN NORTHEAST LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number68305
Policy instance 1
Insurance contract or identification number68305
Number of Individuals Covered15
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,005
Total amount of fees paid to insurance companyUSD $515
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,005
Insurance broker organization code?3
Amount paid for insurance broker fees515
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePENRET SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number68305
Policy instance 1
Insurance contract or identification number68305
Number of Individuals Covered15
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,314
Total amount of fees paid to insurance companyUSD $437
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?Yes
Commission paid to Insurance BrokerUSD $3,314
Insurance broker organization code?3
Amount paid for insurance broker fees437
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePENRET SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number68305
Policy instance 1
Insurance contract or identification number68305
Number of Individuals Covered15
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,789
Total amount of fees paid to insurance companyUSD $463
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,789
Insurance broker organization code?3
Amount paid for insurance broker fees363
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker namePENRET SERVICES, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number68305
Policy instance 1
Insurance contract or identification number68305
Number of Individuals Covered15
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,690
Total amount of fees paid to insurance companyUSD $432
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?Yes
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number68305
Policy instance 1
Insurance contract or identification number68305
Number of Individuals Covered15
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,226
Total amount of fees paid to insurance companyUSD $100
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?Yes
Commission paid to Insurance BrokerUSD $2,226
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTPA COMPENSATION
Amount paid for insurance broker fees100
Insurance broker namePENRET SERVICES, INC.

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