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PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 401k Plan overview

Plan NamePHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN
Plan identification number 001

PHOENIX ANESTHESIA, P.A. 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
  • 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

PHOENIX ANESTHESIA, P.A. has sponsored the creation of one or more 401k plans.

Company Name:PHOENIX ANESTHESIA, P.A.
Employer identification number (EIN):263026705
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-10-01
0012021-10-01
0012020-10-01
0012019-10-01
0012018-10-01
0012018-10-01
0012017-10-01
0012016-10-01MARK D TEETER
0012015-10-01MARK D TEETER
0012014-10-01MARK D TEETER
0012013-10-01MARK D TEETER
0012012-10-01MARK D TEETER
0012011-10-01MARK D TEETER
0012010-10-01MARK TEETER
0012009-10-01MARK D TEETER

Plan Statistics for PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN

401k plan membership statisitcs for PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN

Measure Date Value
2017: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-014
Total number of active participants reported on line 7a of the Form 55002017-10-015
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-10-010
Total participants2017-10-015
Number of participants with account balances2017-10-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-10-010
2016: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-014
Total number of active participants reported on line 7a of the Form 55002016-10-014
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-10-010
Total participants2016-10-014
Number of participants with account balances2016-10-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-10-010
2015: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-014
Total number of active participants reported on line 7a of the Form 55002015-10-014
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-10-010
Total participants2015-10-014
Number of participants with account balances2015-10-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-10-010
2014: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-013
Total number of active participants reported on line 7a of the Form 55002014-10-014
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-10-010
Total participants2014-10-014
Number of participants with account balances2014-10-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-10-010
2013: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-013
Total number of active participants reported on line 7a of the Form 55002013-10-013
Total of all active and inactive participants2013-10-013
Total participants2013-10-013
Number of participants with account balances2013-10-013
2012: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-013
Total number of active participants reported on line 7a of the Form 55002012-10-013
Total of all active and inactive participants2012-10-013
Total participants2012-10-013
Number of participants with account balances2012-10-013
2011: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-013
Total number of active participants reported on line 7a of the Form 55002011-10-013
Total of all active and inactive participants2011-10-013
Total participants2011-10-013
Number of participants with account balances2011-10-013
2010: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-013
Total number of active participants reported on line 7a of the Form 55002010-10-013
Total of all active and inactive participants2010-10-013
Total participants2010-10-013
Number of participants with account balances2010-10-013
2009: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-013
Total number of active participants reported on line 7a of the Form 55002009-10-013
Total of all active and inactive participants2009-10-013
Total participants2009-10-013
Number of participants with account balances2009-10-013

Financial Data on PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN

Measure Date Value
2017 : PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-09-30$510,512
Expenses. Total of all expenses incurred2017-09-30$29,800
Total plan assets at end of year2017-09-30$3,399,683
Total plan assets at beginning of year2017-09-30$2,918,971
Value of fidelity bond covering the plan2017-09-30$339,968
Other income received2017-09-30$346,183
Net income (gross income less expenses)2017-09-30$480,712
Net plan assets at end of year (total assets less liabilities)2017-09-30$3,399,683
Net plan assets at beginning of year (total assets less liabilities)2017-09-30$2,918,971
Assets. Value of participant loans2017-09-30$3,563
Total contributions received or receivable from employer(s)2017-09-30$164,329
Expenses. Administrative service providers (salaries,fees and commissions)2017-09-30$29,800
2016 : PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan2016-09-30$25,171
Total income from all sources2016-09-30$433,190
Expenses. Total of all expenses incurred2016-09-30$25,196
Total plan assets at end of year2016-09-30$2,918,971
Total plan assets at beginning of year2016-09-30$2,485,806
Value of fidelity bond covering the plan2016-09-30$291,897
Other income received2016-09-30$231,271
Net income (gross income less expenses)2016-09-30$407,994
Net plan assets at end of year (total assets less liabilities)2016-09-30$2,918,971
Net plan assets at beginning of year (total assets less liabilities)2016-09-30$2,485,806
Assets. Value of participant loans2016-09-30$7,713
Total contributions received or receivable from employer(s)2016-09-30$201,919
Expenses. Administrative service providers (salaries,fees and commissions)2016-09-30$25,196
2015 : PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-09-30$-11,955
Expenses. Total of all expenses incurred2015-09-30$20,566
Total plan assets at end of year2015-09-30$2,485,806
Total plan assets at beginning of year2015-09-30$2,518,327
Value of fidelity bond covering the plan2015-09-30$248,581
Other income received2015-09-30$-169,206
Net income (gross income less expenses)2015-09-30$-32,521
Net plan assets at end of year (total assets less liabilities)2015-09-30$2,485,806
Net plan assets at beginning of year (total assets less liabilities)2015-09-30$2,518,327
Assets. Value of participant loans2015-09-30$12,387
Total contributions received or receivable from employer(s)2015-09-30$157,251
Expenses. Administrative service providers (salaries,fees and commissions)2015-09-30$20,566
2014 : PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-09-30$315,575
Expenses. Total of all expenses incurred2014-09-30$16,478
Total plan assets at end of year2014-09-30$2,518,327
Total plan assets at beginning of year2014-09-30$2,219,230
Value of fidelity bond covering the plan2014-09-30$251,833
Expenses. Other expenses not covered elsewhere2014-09-30$16,478
Other income received2014-09-30$183,162
Net income (gross income less expenses)2014-09-30$299,097
Net plan assets at end of year (total assets less liabilities)2014-09-30$2,518,327
Net plan assets at beginning of year (total assets less liabilities)2014-09-30$2,219,230
Total contributions received or receivable from employer(s)2014-09-30$132,413
2013 : PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-09-30$296,027
Expenses. Total of all expenses incurred2013-09-30$11,647
Total plan assets at end of year2013-09-30$2,219,230
Total plan assets at beginning of year2013-09-30$1,934,850
Value of fidelity bond covering the plan2013-09-30$221,923
Expenses. Other expenses not covered elsewhere2013-09-30$11,647
Other income received2013-09-30$164,660
Net income (gross income less expenses)2013-09-30$284,380
Net plan assets at end of year (total assets less liabilities)2013-09-30$2,219,230
Net plan assets at beginning of year (total assets less liabilities)2013-09-30$1,934,850
Total contributions received or receivable from employer(s)2013-09-30$131,367
2012 : PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-09-30$329,159
Expenses. Total of all expenses incurred2012-09-30$8,181
Total plan assets at end of year2012-09-30$1,812,348
Total plan assets at beginning of year2012-09-30$1,491,370
Expenses. Other expenses not covered elsewhere2012-09-30$8,181
Other income received2012-09-30$201,926
Net income (gross income less expenses)2012-09-30$320,978
Net plan assets at end of year (total assets less liabilities)2012-09-30$1,812,348
Net plan assets at beginning of year (total assets less liabilities)2012-09-30$1,491,370
Total contributions received or receivable from employer(s)2012-09-30$127,233
2011 : PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-09-30$122
Total income from all sources2011-09-30$93,732
Expenses. Total of all expenses incurred2011-09-30$4,629
Total plan assets at end of year2011-09-30$1,491,370
Total plan assets at beginning of year2011-09-30$1,402,145
Expenses. Other expenses not covered elsewhere2011-09-30$4,629
Other income received2011-09-30$-35,631
Net income (gross income less expenses)2011-09-30$89,103
Net plan assets at end of year (total assets less liabilities)2011-09-30$1,491,370
Net plan assets at beginning of year (total assets less liabilities)2011-09-30$1,402,145
Total contributions received or receivable from employer(s)2011-09-30$129,363

Form 5500 Responses for PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN

2017: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan benefit arrangement - TrustYes
2016: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan benefit arrangement - TrustYes
2015: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan benefit arrangement - TrustYes
2014: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan benefit arrangement - TrustYes
2013: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan benefit arrangement - TrustYes
2012: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan benefit arrangement - TrustYes
2011: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedYes
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan benefit arrangement - TrustYes
2010: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedYes
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan funding arrangement – TrustYes
2010-10-01Plan benefit arrangement - TrustYes
2009: PHOENIX ANESTHESIA, P.A. PROFIT SHARING PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – TrustYes
2009-10-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3502742766
Policy instance 5
Insurance contract or identification number3502742766
Number of Individuals Covered1
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of fees paid to insurance companyUSD $11,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742667
Policy instance 4
Insurance contract or identification number3202742667
Number of Individuals Covered1
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of fees paid to insurance companyUSD $10,033
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 number8132266
Policy instance 3
Insurance contract or identification number8132266
Number of Individuals Covered1
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of fees paid to insurance companyUSD $2,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202190040
Policy instance 2
Insurance contract or identification number3202190040
Number of Individuals Covered1
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of fees paid to insurance companyUSD $10,410
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 number8131725
Policy instance 1
Insurance contract or identification number8131725
Number of Individuals Covered1
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of fees paid to insurance companyUSD $4,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742667
Policy instance 4
Insurance contract or identification number3202742667
Number of Individuals Covered1
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
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 number8132266
Policy instance 3
Insurance contract or identification number8132266
Number of Individuals Covered1
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202190040
Policy instance 2
Insurance contract or identification number3202190040
Number of Individuals Covered1
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
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 number8131725
Policy instance 1
Insurance contract or identification number8131725
Number of Individuals Covered1
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3502742766
Policy instance 5
Insurance contract or identification number3502742766
Number of Individuals Covered1
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742766
Policy instance 5
Insurance contract or identification number3202742766
Number of Individuals Covered1
Total amount of fees paid to insurance companyUSD $9,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees9188
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742667
Policy instance 4
Insurance contract or identification number3202742667
Number of Individuals Covered1
Total amount of fees paid to insurance companyUSD $7,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7834
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker nameDON R MCDONALD
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202190040
Policy instance 2
Insurance contract or identification number3202190040
Number of Individuals Covered1
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 number8131725
Policy instance 1
Insurance contract or identification number8131725
Number of Individuals Covered1
Total amount of fees paid to insurance companyUSD $3,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3573
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number8132266
Policy instance 3
Insurance contract or identification number8132266
Number of Individuals Covered1
Total amount of fees paid to insurance companyUSD $1,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1966
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742766
Policy instance 1
Insurance contract or identification number3202742766
Total amount of fees paid to insurance companyUSD $7,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7944
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742667
Policy instance 2
Insurance contract or identification number3202742667
Total amount of fees paid to insurance companyUSD $6,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6791
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number8132266
Policy instance 3
Insurance contract or identification number8132266
Total amount of fees paid to insurance companyUSD $1,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1853
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202190040
Policy instance 4
Insurance contract or identification number3202190040
Total amount of fees paid to insurance companyUSD $6,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6679
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number8131725
Policy instance 5
Insurance contract or identification number8131725
Number of Individuals Covered1
Total amount of fees paid to insurance companyUSD $3,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3365
Additional information about fees paid to insurance brokerANNUAL CONTRACT AND ADMINISTRATION FEE
Insurance broker organization code?7
Insurance broker nameDON R MCDONALD
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202190040
Policy instance 4
Insurance contract or identification number3202190040
Total amount of commissions paid to insurance brokerUSD $1,103
Total amount of fees paid to insurance companyUSD $6,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742766
Policy instance 1
Insurance contract or identification number3202742766
Total amount of commissions paid to insurance brokerUSD $1,395
Total amount of fees paid to insurance companyUSD $7,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742667
Policy instance 2
Insurance contract or identification number3202742667
Total amount of commissions paid to insurance brokerUSD $3,497
Total amount of fees paid to insurance companyUSD $6,034
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 number8132266
Policy instance 3
Insurance contract or identification number8132266
Total amount of fees paid to insurance companyUSD $1,704
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 number8131725
Policy instance 5
Insurance contract or identification number8131725
Number of Individuals Covered1
Total amount of fees paid to insurance companyUSD $3,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202190040
Policy instance 2
Insurance contract or identification number3202190040
Number of Individuals Covered1
Total amount of commissions paid to insurance brokerUSD $6,075
Total amount of fees paid to insurance companyUSD $4,963
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
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742766
Policy instance 5
Insurance contract or identification number3202742766
Number of Individuals Covered1
Total amount of fees paid to insurance companyUSD $5,537
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?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
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number3202742667
Policy instance 4
Insurance contract or identification number3202742667
Number of Individuals Covered1
Total amount of commissions paid to insurance brokerUSD $1,260
Total amount of fees paid to insurance companyUSD $3,614
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 number8132266
Policy instance 3
Insurance contract or identification number8132266
Number of Individuals Covered1
Total amount of commissions paid to insurance brokerUSD $1,260
Total amount of fees paid to insurance companyUSD $1,528
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 number8131725
Policy instance 1
Insurance contract or identification number8131725
Number of Individuals Covered1
Total amount of commissions paid to insurance brokerUSD $4,500
Total amount of fees paid to insurance companyUSD $2,710
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

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