MASTORAN CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION
| Measure | Date | Value |
|---|
| 2022: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-05-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 7 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
| Total of all active and inactive participants | 2022-05-01 | 7 |
| Total participants, beginning-of-year | 2022-02-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 129 |
| Number of retired or separated participants receiving benefits | 2022-02-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
| Total of all active and inactive participants | 2022-02-01 | 141 |
| 2021: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-05-01 | 22 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-05-01 | 14 |
| Number of retired or separated participants receiving benefits | 2021-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-05-01 | 0 |
| Total of all active and inactive participants | 2021-05-01 | 14 |
| Total participants, beginning-of-year | 2021-02-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 129 |
| Number of retired or separated participants receiving benefits | 2021-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-02-01 | 0 |
| Total of all active and inactive participants | 2021-02-01 | 129 |
| 2020: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-05-01 | 30 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 24 |
| Number of retired or separated participants receiving benefits | 2020-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-05-01 | 0 |
| Total of all active and inactive participants | 2020-05-01 | 24 |
| Total participants, beginning-of-year | 2020-02-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 128 |
| Number of retired or separated participants receiving benefits | 2020-02-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
| Total of all active and inactive participants | 2020-02-01 | 130 |
| 2019: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-05-01 | 33 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 27 |
| Number of retired or separated participants receiving benefits | 2019-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-05-01 | 0 |
| Total of all active and inactive participants | 2019-05-01 | 27 |
| 2018: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-05-01 | 22 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 16 |
| Number of retired or separated participants receiving benefits | 2018-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-05-01 | 0 |
| Total of all active and inactive participants | 2018-05-01 | 16 |
| 2017: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-05-01 | 21 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 18 |
| Number of retired or separated participants receiving benefits | 2017-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-05-01 | 0 |
| Total of all active and inactive participants | 2017-05-01 | 18 |
| 2016: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-05-01 | 23 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 13 |
| Number of retired or separated participants receiving benefits | 2016-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-05-01 | 0 |
| Total of all active and inactive participants | 2016-05-01 | 13 |
| 2015: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-05-01 | 16 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 16 |
| Number of retired or separated participants receiving benefits | 2015-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-05-01 | 0 |
| Total of all active and inactive participants | 2015-05-01 | 16 |
| Total participants, beginning-of-year | 2015-02-01 | 21 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 21 |
| Number of retired or separated participants receiving benefits | 2015-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-02-01 | 0 |
| Total of all active and inactive participants | 2015-02-01 | 21 |
| Measure | Date | Value |
|---|
| 2023 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2023 401k financial data |
|---|
| Total income from all sources | 2023-04-30 | $78,862 |
| Expenses. Total of all expenses incurred | 2023-04-30 | $86,678 |
| Benefits paid (including direct rollovers) | 2023-04-30 | $39,087 |
| Total plan assets at beginning of year | 2023-04-30 | $7,816 |
| Value of fidelity bond covering the plan | 2023-04-30 | $4,000 |
| Expenses. Other expenses not covered elsewhere | 2023-04-30 | $47,591 |
| Net income (gross income less expenses) | 2023-04-30 | $-7,816 |
| Net plan assets at end of year (total assets less liabilities) | 2023-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-04-30 | $7,816 |
| Total contributions received or receivable from employer(s) | 2023-04-30 | $78,862 |
| 2022 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2022 401k financial data |
|---|
| Total income from all sources | 2022-04-30 | $63,536 |
| Expenses. Total of all expenses incurred | 2022-04-30 | $56,754 |
| Benefits paid (including direct rollovers) | 2022-04-30 | $20,323 |
| Total plan assets at end of year | 2022-04-30 | $7,816 |
| Total plan assets at beginning of year | 2022-04-30 | $1,034 |
| Value of fidelity bond covering the plan | 2022-04-30 | $3,000 |
| Expenses. Other expenses not covered elsewhere | 2022-04-30 | $36,431 |
| Net income (gross income less expenses) | 2022-04-30 | $6,782 |
| Net plan assets at end of year (total assets less liabilities) | 2022-04-30 | $7,816 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-04-30 | $1,034 |
| Total contributions received or receivable from employer(s) | 2022-04-30 | $63,536 |
| 2021 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2021 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2021-04-30 | $0 |
| Total income from all sources | 2021-04-30 | $105,262 |
| Expenses. Total of all expenses incurred | 2021-04-30 | $104,228 |
| Benefits paid (including direct rollovers) | 2021-04-30 | $44,443 |
| Total plan assets at end of year | 2021-04-30 | $1,034 |
| Total plan assets at beginning of year | 2021-04-30 | $0 |
| Value of fidelity bond covering the plan | 2021-04-30 | $10,000 |
| Expenses. Other expenses not covered elsewhere | 2021-04-30 | $59,785 |
| Net income (gross income less expenses) | 2021-04-30 | $1,034 |
| Net plan assets at end of year (total assets less liabilities) | 2021-04-30 | $1,034 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-04-30 | $0 |
| Total contributions received or receivable from employer(s) | 2021-04-30 | $105,262 |
| 2020 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-04-30 | $0 |
| Total plan liabilities at beginning of year | 2020-04-30 | $0 |
| Total income from all sources | 2020-04-30 | $99,410 |
| Expenses. Total of all expenses incurred | 2020-04-30 | $99,410 |
| Benefits paid (including direct rollovers) | 2020-04-30 | $41,614 |
| Total plan assets at end of year | 2020-04-30 | $0 |
| Total plan assets at beginning of year | 2020-04-30 | $0 |
| Value of fidelity bond covering the plan | 2020-04-30 | $10,000 |
| Expenses. Other expenses not covered elsewhere | 2020-04-30 | $57,796 |
| Net income (gross income less expenses) | 2020-04-30 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2020-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-04-30 | $0 |
| Total contributions received or receivable from employer(s) | 2020-04-30 | $99,410 |
| 2018 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-04-30 | $0 |
| Total plan liabilities at beginning of year | 2018-04-30 | $0 |
| Total income from all sources | 2018-04-30 | $52,649 |
| Expenses. Total of all expenses incurred | 2018-04-30 | $57,175 |
| Benefits paid (including direct rollovers) | 2018-04-30 | $25,070 |
| Total plan assets at end of year | 2018-04-30 | $0 |
| Total plan assets at beginning of year | 2018-04-30 | $4,526 |
| Value of fidelity bond covering the plan | 2018-04-30 | $10,000 |
| Expenses. Other expenses not covered elsewhere | 2018-04-30 | $32,105 |
| Net income (gross income less expenses) | 2018-04-30 | $-4,526 |
| Net plan assets at end of year (total assets less liabilities) | 2018-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-04-30 | $4,526 |
| Total contributions received or receivable from employer(s) | 2018-04-30 | $52,649 |
| 2017 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-04-30 | $0 |
| Total plan liabilities at beginning of year | 2017-04-30 | $0 |
| Total income from all sources | 2017-04-30 | $55,146 |
| Expenses. Total of all expenses incurred | 2017-04-30 | $54,253 |
| Benefits paid (including direct rollovers) | 2017-04-30 | $20,703 |
| Total plan assets at end of year | 2017-04-30 | $4,526 |
| Total plan assets at beginning of year | 2017-04-30 | $3,633 |
| Value of fidelity bond covering the plan | 2017-04-30 | $10,000 |
| Expenses. Other expenses not covered elsewhere | 2017-04-30 | $33,550 |
| Net income (gross income less expenses) | 2017-04-30 | $893 |
| Net plan assets at end of year (total assets less liabilities) | 2017-04-30 | $4,526 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-04-30 | $3,633 |
| Total contributions received or receivable from employer(s) | 2017-04-30 | $55,146 |
| 2016 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-04-30 | $0 |
| Total plan liabilities at beginning of year | 2016-04-30 | $0 |
| Total income from all sources | 2016-04-30 | $69,702 |
| Expenses. Total of all expenses incurred | 2016-04-30 | $66,069 |
| Benefits paid (including direct rollovers) | 2016-04-30 | $22,965 |
| Total plan assets at end of year | 2016-04-30 | $3,633 |
| Total plan assets at beginning of year | 2016-04-30 | $0 |
| Value of fidelity bond covering the plan | 2016-04-30 | $10,000 |
| Expenses. Other expenses not covered elsewhere | 2016-04-30 | $43,104 |
| Net income (gross income less expenses) | 2016-04-30 | $3,633 |
| Net plan assets at end of year (total assets less liabilities) | 2016-04-30 | $3,633 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-04-30 | $0 |
| Total contributions received or receivable from employer(s) | 2016-04-30 | $69,702 |
| 2015 : EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-04-30 | $0 |
| Total income from all sources | 2015-04-30 | $0 |
| Expenses. Total of all expenses incurred | 2015-04-30 | $0 |
| Total plan assets at end of year | 2015-04-30 | $0 |
| Value of fidelity bond covering the plan | 2015-04-30 | $10,000 |
| Net income (gross income less expenses) | 2015-04-30 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2015-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-04-30 | $0 |
| 2022: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2022 form 5500 responses |
|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Submission has been amended | No |
| 2022-05-01 | This submission is the final filing | No |
| 2022-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-05-01 | Plan is a collectively bargained plan | No |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan funding arrangement – Trust | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement - Trust | Yes |
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | Submission has been amended | No |
| 2022-02-01 | This submission is the final filing | No |
| 2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-02-01 | Plan is a collectively bargained plan | No |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2021 form 5500 responses |
|---|
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Submission has been amended | No |
| 2021-05-01 | This submission is the final filing | No |
| 2021-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-05-01 | Plan is a collectively bargained plan | No |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan funding arrangement – Trust | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement - Trust | Yes |
| 2021-02-01 | Type of plan entity | Single employer plan |
| 2021-02-01 | Submission has been amended | No |
| 2021-02-01 | This submission is the final filing | No |
| 2021-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-02-01 | Plan is a collectively bargained plan | No |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2020 form 5500 responses |
|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Submission has been amended | No |
| 2020-05-01 | This submission is the final filing | No |
| 2020-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-05-01 | Plan is a collectively bargained plan | No |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan funding arrangement – Trust | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement - Trust | Yes |
| 2020-02-01 | Type of plan entity | Single employer plan |
| 2020-02-01 | First time form 5500 has been submitted | Yes |
| 2020-02-01 | Submission has been amended | No |
| 2020-02-01 | This submission is the final filing | No |
| 2020-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-02-01 | Plan is a collectively bargained plan | No |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2019 form 5500 responses |
|---|
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Submission has been amended | No |
| 2019-05-01 | This submission is the final filing | No |
| 2019-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-05-01 | Plan is a collectively bargained plan | No |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan funding arrangement – Trust | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement - Trust | Yes |
| 2018: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2018 form 5500 responses |
|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Submission has been amended | No |
| 2018-05-01 | This submission is the final filing | No |
| 2018-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-05-01 | Plan is a collectively bargained plan | No |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan funding arrangement – Trust | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement - Trust | Yes |
| 2017: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2017 form 5500 responses |
|---|
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | Submission has been amended | No |
| 2017-05-01 | This submission is the final filing | No |
| 2017-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-05-01 | Plan is a collectively bargained plan | No |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan funding arrangement – Trust | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement - Trust | Yes |
| 2016: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2016 form 5500 responses |
|---|
| 2016-05-01 | Type of plan entity | Single employer plan |
| 2016-05-01 | Submission has been amended | No |
| 2016-05-01 | This submission is the final filing | No |
| 2016-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-05-01 | Plan is a collectively bargained plan | No |
| 2016-05-01 | Plan funding arrangement – Insurance | Yes |
| 2016-05-01 | Plan funding arrangement – Trust | Yes |
| 2016-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-05-01 | Plan benefit arrangement - Trust | Yes |
| 2015: EMPLOYEE HEALTH PLAN OF MASTORAN CORPORATION 2015 form 5500 responses |
|---|
| 2015-05-01 | Type of plan entity | Single employer plan |
| 2015-05-01 | Submission has been amended | No |
| 2015-05-01 | This submission is the final filing | No |
| 2015-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-05-01 | Plan is a collectively bargained plan | No |
| 2015-05-01 | Plan funding arrangement – Insurance | Yes |
| 2015-05-01 | Plan funding arrangement – Trust | Yes |
| 2015-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-05-01 | Plan benefit arrangement - Trust | Yes |
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | First time form 5500 has been submitted | Yes |
| 2015-02-01 | Submission has been amended | No |
| 2015-02-01 | This submission is the final filing | No |
| 2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-02-01 | Plan is a collectively bargained plan | No |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan funding arrangement – Trust | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement - Trust | Yes |
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA 0586 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA 0586 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $33,757 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4951521 |
| Policy instance | 2 |
| Insurance contract or identification number | 4951521 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $39,187 | | Total amount of fees paid to insurance company | USD $6,720 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,251,279 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $39,187 | | Amount paid for insurance broker fees | 6720 | | Additional information about fees paid to insurance broker | COMMISSIONS AND OTHER COMMISSIONS | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50008131 |
| Policy instance | 1 |
| Insurance contract or identification number | 50008131 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $6,708 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $44,723 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,708 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA 0586 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA 0586 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $26,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4951521 |
| Policy instance | 2 |
| Insurance contract or identification number | 4951521 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $37,090 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,146,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $37,090 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50008131 |
| Policy instance | 1 |
| Insurance contract or identification number | 50008131 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $6,626 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $40,577 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,626 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA 0586 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA 0586 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $43,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4951521 |
| Policy instance | 2 |
| Insurance contract or identification number | 4951521 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $35,815 | | Total amount of fees paid to insurance company | USD $6,320 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,129,255 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,815 | | Amount paid for insurance broker fees | 6320 | | Additional information about fees paid to insurance broker | COMMISSIONS AND FEES | | Insurance broker organization code? | 3 |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50008131 |
| Policy instance | 1 |
| Insurance contract or identification number | 50008131 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $10,196 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $67,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,196 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA 0586 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA 0586 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $41,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA 0586 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA 0586 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $28,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA 0586 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA 0586 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $22,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA 0580 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA 0580 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $27,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 14434 NFA0494 |
| Policy instance | 1 |
| Insurance contract or identification number | 14434 NFA0494 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2015-04-30 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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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