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SPECIALTY HEALTH 401K PROFIT SHARING PLAN 401k Plan overview

Plan NameSPECIALTY HEALTH 401K PROFIT SHARING PLAN
Plan identification number 001

SPECIALTY HEALTH 401K PROFIT SHARING PLAN Benefits

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

401k Sponsoring company profile

SPECIALTY HEALTH, INC. has sponsored the creation of one or more 401k plans.

Company Name:SPECIALTY HEALTH, INC.
Employer identification number (EIN):880363603
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPECIALTY HEALTH 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01SHERRI BREWER2024-09-30
0012022-01-01SHERRI SEAWELL2023-06-22
0012021-01-01JACQUELINE COX2022-08-29
0012020-01-01JACQUELINE COX2021-07-21
0012019-01-01JACQUELINE COX2020-10-15
0012018-01-01JACQUELINE COX2019-10-09 JACQUELINE COX2019-10-09
0012017-01-01JACQUELINE COX2018-10-11 JACQUELINE COX2018-10-11
0012016-01-01CINDY WELLER CINDY WELLER2017-10-12
0012015-01-01JACQUELINE COX JACQUELINE COX2016-10-13
0012014-01-01JACQUELINE COX
0012013-01-01JACQUELINE COX
0012012-01-01JACQUELINE COX
0012011-01-01JACQUELINE COX
0012010-01-01JACQUELINE COX

Plan Statistics for SPECIALTY HEALTH 401K PROFIT SHARING PLAN

401k plan membership statisitcs for SPECIALTY HEALTH 401K PROFIT SHARING PLAN

Measure Date Value
2016: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0121
Total number of active participants reported on line 7a of the Form 55002016-01-0122
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0122
Number of participants with account balances2016-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0123
Total number of active participants reported on line 7a of the Form 55002015-01-0121
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0121
Number of participants with account balances2015-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0126
Total number of active participants reported on line 7a of the Form 55002014-01-0122
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0122
Number of participants with account balances2014-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0131
Total number of active participants reported on line 7a of the Form 55002013-01-0126
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0126
Number of participants with account balances2013-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0146
Total number of active participants reported on line 7a of the Form 55002012-01-0124
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0124
Number of participants with account balances2012-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0144
Total number of active participants reported on line 7a of the Form 55002011-01-0144
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0144
Number of participants with account balances2011-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0142
Total number of active participants reported on line 7a of the Form 55002010-01-0140
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-012
Total of all active and inactive participants2010-01-0142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0142
Number of participants with account balances2010-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010

Financial Data on SPECIALTY HEALTH 401K PROFIT SHARING PLAN

Measure Date Value
2016 : SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$137,960
Expenses. Total of all expenses incurred2016-12-31$344,742
Benefits paid (including direct rollovers)2016-12-31$340,568
Total plan assets at end of year2016-12-31$614,254
Total plan assets at beginning of year2016-12-31$821,036
Value of fidelity bond covering the plan2016-12-31$300,000
Total contributions received or receivable from participants2016-12-31$90,198
Other income received2016-12-31$10,337
Net income (gross income less expenses)2016-12-31$-206,782
Net plan assets at end of year (total assets less liabilities)2016-12-31$614,254
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$821,036
Assets. Value of participant loans2016-12-31$8,887
Assets. Value of real-estate (other than employer real property)2016-12-31$0
Total contributions received or receivable from employer(s)2016-12-31$37,425
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$4,174
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan2015-12-31$0
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$124,215
Expenses. Total of all expenses incurred2015-12-31$28,524
Benefits paid (including direct rollovers)2015-12-31$19,903
Total plan assets at end of year2015-12-31$821,036
Total plan assets at beginning of year2015-12-31$725,345
Value of fidelity bond covering the plan2015-12-31$400,000
Total contributions received or receivable from participants2015-12-31$91,914
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$-8,502
Net income (gross income less expenses)2015-12-31$95,691
Net plan assets at end of year (total assets less liabilities)2015-12-31$821,036
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$725,345
Assets. Value of participant loans2015-12-31$17,810
Assets. Value of real-estate (other than employer real property)2015-12-31$246,852
Total contributions received or receivable from employer(s)2015-12-31$40,803
Value of certain deemed distributions of participant loans2015-12-31$8,621
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$98,621
Expenses. Total of all expenses incurred2014-12-31$43,564
Benefits paid (including direct rollovers)2014-12-31$21,878
Total plan assets at end of year2014-12-31$725,345
Total plan assets at beginning of year2014-12-31$670,288
Value of fidelity bond covering the plan2014-12-31$400,000
Total contributions received or receivable from participants2014-12-31$87,325
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$-27,887
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$55,057
Net plan assets at end of year (total assets less liabilities)2014-12-31$725,345
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$670,288
Assets. Value of participant loans2014-12-31$26,747
Assets. Value of real-estate (other than employer real property)2014-12-31$242,017
Total contributions received or receivable from employer(s)2014-12-31$39,183
Value of certain deemed distributions of participant loans2014-12-31$1,709
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$19,977
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$154,136
Expenses. Total of all expenses incurred2013-12-31$118,127
Benefits paid (including direct rollovers)2013-12-31$85,923
Total plan assets at end of year2013-12-31$670,288
Total plan assets at beginning of year2013-12-31$634,279
Value of fidelity bond covering the plan2013-12-31$325,000
Total contributions received or receivable from participants2013-12-31$57,937
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$66,704
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$36,009
Net plan assets at end of year (total assets less liabilities)2013-12-31$670,288
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$634,279
Assets. Value of participant loans2013-12-31$45,776
Assets. Value of real-estate (other than employer real property)2013-12-31$287,600
Total contributions received or receivable from employer(s)2013-12-31$29,495
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$32,204
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$191
Total income from all sources2012-12-31$163,405
Expenses. Total of all expenses incurred2012-12-31$221,243
Benefits paid (including direct rollovers)2012-12-31$186,139
Total plan assets at end of year2012-12-31$634,279
Total plan assets at beginning of year2012-12-31$692,308
Value of fidelity bond covering the plan2012-12-31$300,000
Total contributions received or receivable from participants2012-12-31$58,042
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$73,518
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$-57,838
Net plan assets at end of year (total assets less liabilities)2012-12-31$634,279
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$692,117
Assets. Value of real-estate (other than employer real property)2012-12-31$271,600
Total contributions received or receivable from employer(s)2012-12-31$31,845
Value of certain deemed distributions of participant loans2012-12-31$708
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$34,396
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$191
Total plan liabilities at beginning of year2011-12-31$191
Total income from all sources2011-12-31$113,275
Expenses. Total of all expenses incurred2011-12-31$65,311
Benefits paid (including direct rollovers)2011-12-31$28,856
Total plan assets at end of year2011-12-31$692,308
Total plan assets at beginning of year2011-12-31$644,344
Value of fidelity bond covering the plan2011-12-31$300,000
Total contributions received or receivable from participants2011-12-31$62,057
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$16,299
Other income received2011-12-31$679
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$47,964
Net plan assets at end of year (total assets less liabilities)2011-12-31$692,117
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$644,153
Assets. Value of participant loans2011-12-31$12
Assets. Value of real-estate (other than employer real property)2011-12-31$252,000
Total contributions received or receivable from employer(s)2011-12-31$34,240
Value of certain deemed distributions of participant loans2011-12-31$6,998
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$29,457
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$191
Total plan liabilities at beginning of year2010-12-31$191
Total income from all sources2010-12-31$227,117
Expenses. Total of all expenses incurred2010-12-31$10,467
Benefits paid (including direct rollovers)2010-12-31$193
Total plan assets at end of year2010-12-31$644,344
Total plan assets at beginning of year2010-12-31$427,694
Value of fidelity bond covering the plan2010-12-31$50,000
Total contributions received or receivable from participants2010-12-31$54,304
Expenses. Other expenses not covered elsewhere2010-12-31$6
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$146,853
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$216,650
Net plan assets at end of year (total assets less liabilities)2010-12-31$644,153
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$427,503
Assets. Value of participant loans2010-12-31$15,785
Assets. Value of real-estate (other than employer real property)2010-12-31$243,300
Total contributions received or receivable from employer(s)2010-12-31$25,960
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$10,268
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0

Form 5500 Responses for SPECIALTY HEALTH 401K PROFIT SHARING PLAN

2016: SPECIALTY HEALTH 401K 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 - TrustYes
2015: SPECIALTY HEALTH 401K 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 - TrustYes
2014: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: SPECIALTY HEALTH 401K PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – 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 number15126
Policy instance 1
Insurance contract or identification number15126
Number of Individuals Covered11
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,994
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,529
Insurance broker organization code?4
Insurance broker nameSUNWEST PENSIONS
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number15126
Policy instance 1
Insurance contract or identification number15126
Number of Individuals Covered12
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,964
Total amount of fees paid to insurance companyUSD $16
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,964
Insurance broker organization code?4
Amount paid for insurance broker fees16
Additional information about fees paid to insurance brokerTPA FEES PAID
Insurance broker nameSUNWEST PENSIONS
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number15126
Policy instance 1
Insurance contract or identification number15126
Number of Individuals Covered11
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,600
Total amount of fees paid to insurance companyUSD $177
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,600
Insurance broker organization code?4
Amount paid for insurance broker fees177
Additional information about fees paid to insurance brokerTPA FEES PAID
Insurance broker nameSUNWEST PENSIONS
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number15126
Policy instance 1
Insurance contract or identification number15126
Number of Individuals Covered10
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,252
Total amount of fees paid to insurance companyUSD $1,090
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?Yes
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
Other information about contractGROUP ANNUITY
Commission paid to Insurance BrokerUSD $2,252
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?4
Insurance broker nameKROPKOF PENSION SERVICES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number15126
Policy instance 1
Insurance contract or identification number15126
Number of Individuals Covered16
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,063
Total amount of fees paid to insurance companyUSD $340
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?Yes
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
Other information about contractGROUP ANNUITY
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number15126
Policy instance 1
Insurance contract or identification number15126
Number of Individuals Covered12
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,956
Total amount of fees paid to insurance companyUSD $140
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?Yes
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
Other information about contractGROUP ANNUITY
Commission paid to Insurance BrokerUSD $1,956
Insurance broker organization code?4
Amount paid for insurance broker fees140
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker nameKROPKOF PENSION SERVICES

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