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ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN
Plan identification number 001

ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ATA DENTAL ASSOCIATES, P.A. has sponsored the creation of one or more 401k plans.

Company Name:ATA DENTAL ASSOCIATES, P.A.
Employer identification number (EIN):593051126
NAIC Classification:621210
NAIC Description:Offices of Dentists

Additional information about ATA DENTAL ASSOCIATES, P.A.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1991-02-14
Company Identification Number: S31811
Legal Registered Office Address: 3192 S JONH YOUNG PKWY

KISSIMMEE

34746

More information about ATA DENTAL ASSOCIATES, P.A.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012020-01-01
0012019-01-01OMAR ATA2020-10-15 OMAR ATA2020-10-15
0012018-01-01OMAR ATA OMAR ATA2019-07-22
0012017-01-01
0012016-01-01OMAR ATA OMAR ATA2017-03-26
0012015-01-01OMAR ATA OMAR ATA2016-10-06
0012014-01-01OMAR ATA OMAR ATA2015-09-14
0012013-01-01OMAR ATA OMAR ATA2014-10-10
0012012-01-01OMAR ATA OMAR ATA2013-09-13
0012011-01-01OMAR ATA OMAR ATA2012-10-10
0012010-01-01OMAR ATA OMAR ATA2012-09-25

Plan Statistics for ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2019: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0116
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-015
Total of all active and inactive participants2019-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-015
Number of participants with account balances2019-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0115
Total number of active participants reported on line 7a of the Form 55002018-01-0114
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0114
Number of participants with account balances2018-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0115
Total number of active participants reported on line 7a of the Form 55002017-01-0114
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0114
Number of participants with account balances2017-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0126
Total number of active participants reported on line 7a of the Form 55002016-01-0119
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0120
Number of participants with account balances2016-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0128
Total number of active participants reported on line 7a of the Form 55002015-01-0122
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-014
Total of all active and inactive participants2015-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0126
Number of participants with account balances2015-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0120
Total number of active participants reported on line 7a of the Form 55002014-01-0114
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 participants2014-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0119
Number of participants with account balances2014-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0121
Total number of active participants reported on line 7a of the Form 55002013-01-0113
Number of other retired or separated participants entitled to future benefits2013-01-017
Total of all active and inactive participants2013-01-0120
Total participants2013-01-0120
Number of participants with account balances2013-01-0113
2012: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0121
Total number of active participants reported on line 7a of the Form 55002012-01-0114
Number of other retired or separated participants entitled to future benefits2012-01-016
Total of all active and inactive participants2012-01-0120
Total participants2012-01-0120
Number of participants with account balances2012-01-0113
2011: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0120
Total number of active participants reported on line 7a of the Form 55002011-01-0120
Total of all active and inactive participants2011-01-0120
Total participants2011-01-0120
Number of participants with account balances2011-01-0112
2010: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0118
Total number of active participants reported on line 7a of the Form 55002010-01-0119
Total of all active and inactive participants2010-01-0119
Total participants2010-01-0119
Number of participants with account balances2010-01-0112

Financial Data on ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2019 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources2019-12-31$16,540
Expenses. Total of all expenses incurred2019-12-31$0
Total plan assets at end of year2019-12-31$217,195
Total plan assets at beginning of year2019-12-31$200,655
Total contributions received or receivable from participants2019-12-31$1,859
Other income received2019-12-31$14,681
Net income (gross income less expenses)2019-12-31$16,540
Net plan assets at end of year (total assets less liabilities)2019-12-31$217,195
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$200,655
Assets. Value of employer securities2019-12-31$126,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$-12,105
Expenses. Total of all expenses incurred2018-12-31$0
Total plan assets at end of year2018-12-31$200,655
Total plan assets at beginning of year2018-12-31$212,760
Total contributions received or receivable from participants2018-12-31$3,827
Other income received2018-12-31$-15,932
Net income (gross income less expenses)2018-12-31$-12,105
Net plan assets at end of year (total assets less liabilities)2018-12-31$200,655
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$212,760
Assets. Value of employer securities2018-12-31$126,000
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$20,240
Expenses. Total of all expenses incurred2017-12-31$148,206
Benefits paid (including direct rollovers)2017-12-31$148,203
Total plan assets at end of year2017-12-31$212,760
Total plan assets at beginning of year2017-12-31$340,726
Total contributions received or receivable from participants2017-12-31$3,827
Other income received2017-12-31$16,413
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$-127,966
Net plan assets at end of year (total assets less liabilities)2017-12-31$212,760
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$340,726
Assets. Value of participant loans2017-12-31$786
Assets. Value of employer securities2017-12-31$132,000
Value of corrective distributions2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$3
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$15,374
Expenses. Total of all expenses incurred2016-12-31$32,424
Benefits paid (including direct rollovers)2016-12-31$29,863
Total plan assets at end of year2016-12-31$340,726
Total plan assets at beginning of year2016-12-31$357,776
Total contributions received or receivable from participants2016-12-31$6,108
Other income received2016-12-31$9,266
Net income (gross income less expenses)2016-12-31$-17,050
Net plan assets at end of year (total assets less liabilities)2016-12-31$340,726
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$357,776
Assets. Value of participant loans2016-12-31$19,900
Assets. Value of employer securities2016-12-31$132,000
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$2,561
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$17,668
Expenses. Total of all expenses incurred2015-12-31$16,816
Benefits paid (including direct rollovers)2015-12-31$14,208
Total plan assets at end of year2015-12-31$357,776
Total plan assets at beginning of year2015-12-31$356,924
Total contributions received or receivable from participants2015-12-31$6,947
Other income received2015-12-31$10,721
Net income (gross income less expenses)2015-12-31$852
Net plan assets at end of year (total assets less liabilities)2015-12-31$357,776
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$356,924
Assets. Value of participant loans2015-12-31$21,262
Assets. Value of employer securities2015-12-31$138,314
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$2,608
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$26,188
Expenses. Total of all expenses incurred2014-12-31$7,827
Benefits paid (including direct rollovers)2014-12-31$5,354
Total plan assets at end of year2014-12-31$356,924
Total plan assets at beginning of year2014-12-31$338,563
Total contributions received or receivable from participants2014-12-31$4,922
Other income received2014-12-31$21,266
Net income (gross income less expenses)2014-12-31$18,361
Net plan assets at end of year (total assets less liabilities)2014-12-31$356,924
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$338,563
Assets. Value of participant loans2014-12-31$22,151
Assets. Value of employer securities2014-12-31$138,314
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$2,473
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$42,696
Expenses. Total of all expenses incurred2013-12-31$2,428
Total plan assets at end of year2013-12-31$338,563
Total plan assets at beginning of year2013-12-31$298,295
Total contributions received or receivable from participants2013-12-31$9,266
Other income received2013-12-31$33,430
Net income (gross income less expenses)2013-12-31$40,268
Net plan assets at end of year (total assets less liabilities)2013-12-31$338,563
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$298,295
Assets. Value of participant loans2013-12-31$25,345
Assets. Value of employer securities2013-12-31$138,313
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$2,428
2012 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$50,715
Expenses. Total of all expenses incurred2012-12-31$2,348
Total plan assets at end of year2012-12-31$298,295
Total plan assets at beginning of year2012-12-31$249,928
Total contributions received or receivable from participants2012-12-31$29,756
Other income received2012-12-31$20,959
Net income (gross income less expenses)2012-12-31$48,367
Net plan assets at end of year (total assets less liabilities)2012-12-31$298,295
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$249,928
Assets. Value of participant loans2012-12-31$26,656
Assets. Value of employer securities2012-12-31$129,485
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$2,348
2011 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$26,816
Expenses. Total of all expenses incurred2011-12-31$2,020
Benefits paid (including direct rollovers)2011-12-31$525
Total plan assets at end of year2011-12-31$249,928
Total plan assets at beginning of year2011-12-31$225,132
Total contributions received or receivable from participants2011-12-31$16,414
Other income received2011-12-31$10,402
Net income (gross income less expenses)2011-12-31$24,796
Net plan assets at end of year (total assets less liabilities)2011-12-31$249,928
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$225,132
Assets. Value of employer securities2011-12-31$129,485
Value of certain deemed distributions of participant loans2011-12-31$1,495
2010 : ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$225,132
Total plan assets at end of year2010-12-31$225,132
Total contributions received or receivable from participants2010-12-31$11,512
Contributions received from other sources (not participants or employers)2010-12-31$195,908
Other income received2010-12-31$17,712
Net income (gross income less expenses)2010-12-31$225,132
Net plan assets at end of year (total assets less liabilities)2010-12-31$225,132
Assets. Value of employer securities2010-12-31$129,485

Form 5500 Responses for ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

2019: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 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: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 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: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 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: ATA DENTAL ASSOCIATES, P.A. 401(K) 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 – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: ATA DENTAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
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 – InsuranceYes
2010-01-01Plan 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 number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $42
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered4
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $41
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $117
Total amount of fees paid to insurance companyUSD $115
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $117
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees115
Insurance broker nameBATES & COMPANY, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered19
Insurance policy start date2016-01-01
Insurance policy end date2016-12-31
Total amount of commissions paid to insurance brokerUSD $424
Total amount of fees paid to insurance companyUSD $206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $424
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTPA FEES AND COMPENSATION
Insurance broker nameBATES & COMPANY, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered9
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $468
Total amount of fees paid to insurance companyUSD $210
Commission paid to Insurance BrokerUSD $468
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees210
Insurance broker nameBATES & COMPANY, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered10
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $476
Total amount of fees paid to insurance companyUSD $60
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $476
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees60
Insurance broker nameBATES & COMPANY, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered12
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $397
Total amount of fees paid to insurance companyUSD $50
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $397
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees50
Insurance broker nameBATES & COMPANY, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered12
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $253
Total amount of fees paid to insurance companyUSD $246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $253
Amount paid for insurance broker fees60
Additional information about fees paid to insurance brokerBROKER COMMISSION & OTHER ALLOWANCES
Insurance broker organization code?3
Insurance broker nameBATES AND COMPANY, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number96051
Policy instance 1
Insurance contract or identification number96051
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $213
Total amount of fees paid to insurance companyUSD $88
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 number96051
Policy instance 1
Insurance contract or identification number96051
Number of Individuals Covered11
Insurance policy start date2010-05-27
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $373
Total amount of fees paid to insurance companyUSD $89
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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