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SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 401k Plan overview

Plan NameSOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN
Plan identification number 502

SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. has sponsored the creation of one or more 401k plans.

Company Name:SOUTH SHORE COMMUNITY ACTION COUNCIL, INC.
Employer identification number (EIN):046125732
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-10-01LYNNE BERGERON2024-01-29
5022021-10-01LYNNE BERGERON2023-03-02
5022020-10-01LYNNE BERGERON2022-04-21
5022019-10-01LYNNE BERGERON2022-02-25

Plan Statistics for SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN

401k plan membership statisitcs for SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN

Measure Date Value
2022: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-10-01174
Total number of active participants reported on line 7a of the Form 55002022-10-01185
Number of retired or separated participants receiving benefits2022-10-010
Number of other retired or separated participants entitled to future benefits2022-10-010
Total of all active and inactive participants2022-10-01185
Number of employers contributing to the scheme2022-10-010
2021: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01180
Total number of active participants reported on line 7a of the Form 55002021-10-01174
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01174
Number of employers contributing to the scheme2021-10-010
2020: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01178
Total number of active participants reported on line 7a of the Form 55002020-10-01180
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01180
Number of employers contributing to the scheme2020-10-010
2019: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01152
Total number of active participants reported on line 7a of the Form 55002019-10-01178
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01178
Number of employers contributing to the scheme2019-10-010

Form 5500 Responses for SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN

2022: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-10-01Type of plan entitySingle employer plan
2022-10-01Plan funding arrangement – InsuranceYes
2022-10-01Plan benefit arrangement – InsuranceYes
2021: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: SOUTH SHORE COMMUNITY ACTION COUNCIL, INC. HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4959221
Policy instance 1
Insurance contract or identification number4959221
Number of Individuals Covered197
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $39,366
Total amount of fees paid to insurance companyUSD $6,300
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $39,366
Amount paid for insurance broker fees6300
Additional information about fees paid to insurance brokerOTHER COMMISSION
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50004181
Policy instance 2
Insurance contract or identification number50004181
Number of Individuals Covered185
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $18,267
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $60,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,267
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4959221
Policy instance 1
Insurance contract or identification number4959221
Number of Individuals Covered192
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $49,997
Total amount of fees paid to insurance companyUSD $14,083
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $49,997
Amount paid for insurance broker fees14083
Additional information about fees paid to insurance brokerOTHER COMMISSION
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50004181
Policy instance 2
Insurance contract or identification number50004181
Number of Individuals Covered174
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $8,279
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $41,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,279
Amount paid for insurance broker fees0
Insurance broker organization code?3
NEIGHBORHOOD HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 11109 )
Policy contract numberTFHMG
Policy instance 1
Insurance contract or identification numberTFHMG
Number of Individuals Covered91
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $36,993
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,777,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $36,993
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number2368574
Policy instance 2
Insurance contract or identification number2368574
Number of Individuals Covered184
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $3,883
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,358
Amount paid for insurance broker fees0
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50004181
Policy instance 3
Insurance contract or identification number50004181
Number of Individuals Covered180
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $8,407
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $42,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,407
Amount paid for insurance broker fees0
Insurance broker organization code?3

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