401k Plan data: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN plan

HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	HUSSON COLLEGE EMPLOYEE BENEFIT PLAN
Plan identification number	503

HUSSON COLLEGE EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental

401k Sponsoring company profile

HUSSON UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name: HUSSON UNIVERSITY

Employer identification number (EIN): 010271210

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HUSSON COLLEGE EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-01-01
503 2016-01-01
503 2015-01-01
503 2014-01-01
503 2013-01-01
503 2012-01-01 MARY DEMERS
503 2011-01-01 MARY DEMERS
503 2010-01-01 MARY DEMERS
503 2009-01-01 NICOLE FLETCHER

Plan Statistics for HUSSON COLLEGE EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for HUSSON COLLEGE EMPLOYEE BENEFIT PLAN

Measure Date Value
2017: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 397
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 393
Number of retired or separated participants receiving benefits 2017-01-01 13
Total of all active and inactive participants 2017-01-01 406
2016: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 301
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 397
Number of retired or separated participants receiving benefits 2016-01-01 13
Total of all active and inactive participants 2016-01-01 410
2015: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 304
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 301
Number of retired or separated participants receiving benefits 2015-01-01 9
Total of all active and inactive participants 2015-01-01 310
2014: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 301
Number of retired or separated participants receiving benefits 2014-01-01 3
Total of all active and inactive participants 2014-01-01 304
2013: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 265
Number of retired or separated participants receiving benefits 2013-01-01 10
Total of all active and inactive participants 2013-01-01 275
2012: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 210
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 224
Number of retired or separated participants receiving benefits 2012-01-01 3
Total of all active and inactive participants 2012-01-01 227
Total participants 2012-01-01 0
2011: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 206
Number of retired or separated participants receiving benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 210
Total participants 2011-01-01 210
2010: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 223
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 178
Number of retired or separated participants receiving benefits 2010-01-01 4
Total of all active and inactive participants 2010-01-01 182
Total participants 2010-01-01 182
2009: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 223
Total of all active and inactive participants 2009-01-01 223
Total participants 2009-01-01 223

Measure	Date	Value
2017: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	397
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	393
Number of retired or separated participants receiving benefits	2017-01-01	13
Total of all active and inactive participants	2017-01-01	406
2016: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	301
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	397
Number of retired or separated participants receiving benefits	2016-01-01	13
Total of all active and inactive participants	2016-01-01	410
2015: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	304
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	301
Number of retired or separated participants receiving benefits	2015-01-01	9
Total of all active and inactive participants	2015-01-01	310
2014: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	301
Number of retired or separated participants receiving benefits	2014-01-01	3
Total of all active and inactive participants	2014-01-01	304
2013: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	265
Number of retired or separated participants receiving benefits	2013-01-01	10
Total of all active and inactive participants	2013-01-01	275
2012: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	210
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	224
Number of retired or separated participants receiving benefits	2012-01-01	3
Total of all active and inactive participants	2012-01-01	227
Total participants	2012-01-01	0
2011: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	206
Number of retired or separated participants receiving benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	210
Total participants	2011-01-01	210
2010: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	223
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	178
Number of retired or separated participants receiving benefits	2010-01-01	4
Total of all active and inactive participants	2010-01-01	182
Total participants	2010-01-01	182
2009: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	223
Total of all active and inactive participants	2009-01-01	223
Total participants	2009-01-01	223

Form 5500 Responses for HUSSON COLLEGE EMPLOYEE BENEFIT PLAN

2017: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: HUSSON COLLEGE EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

095805

Policy instance

Insurance contract or identification number	095805
Number of Individuals Covered	367
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $56,406
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,329,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,406
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

DELTA DENTAL PLAN OF MAINE (National Association of Insurance Commissioners NAIC id number: 14369 )

Policy contract number

61408

Policy instance

Insurance contract or identification number	61408
Number of Individuals Covered	418
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,576
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,576
Insurance broker organization code?	3
Insurance broker name	COMBINED SERVICES LLC

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

056222

Policy instance

Insurance contract or identification number	056222
Number of Individuals Covered	146
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,133
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	HSA
Welfare Benefit Premiums Paid to Carrier	USD $748,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,133
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

095806

Policy instance

Insurance contract or identification number	095806
Number of Individuals Covered	78
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,902
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $492,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,902
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

056222

Policy instance

Insurance contract or identification number	056222
Number of Individuals Covered	74
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,659
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	HSA
Welfare Benefit Premiums Paid to Carrier	USD $128,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,659
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

095806

Policy instance

Insurance contract or identification number	095806
Number of Individuals Covered	104
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,194
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $565,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,194
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

095805

Policy instance

Insurance contract or identification number	095805
Number of Individuals Covered	382
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $55,647
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,217,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,647
Insurance broker name	HOLDEN AGENCY

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

750370

Policy instance

Insurance contract or identification number	750370
Number of Individuals Covered	209
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,968
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,968
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

750370

Policy instance

Insurance contract or identification number	750370
Number of Individuals Covered	176
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,661
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,661
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

095806

Policy instance

Insurance contract or identification number	095806
Number of Individuals Covered	100
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $15,220
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $523,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,194
Insurance broker organization code?	3
Insurance broker name	HEALEY ASSOCIATES INC

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

095805

Policy instance

Insurance contract or identification number	095805
Number of Individuals Covered	332
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $52,364
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,802,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,273
Insurance broker organization code?	3
Insurance broker name	HEALEY & ASSOCIATES INC

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

056222

Policy instance

Insurance contract or identification number	056222
Number of Individuals Covered	37
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,150
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	HSA
Welfare Benefit Premiums Paid to Carrier	USD $177,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,141
Insurance broker organization code?	3
Insurance broker name	HEALEY & ASSOCIATES INC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05573245

Policy instance

Insurance contract or identification number	TM05573245
Number of Individuals Covered	337
Total amount of commissions paid to insurance broker	USD $11,143
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $496
Insurance broker organization code?	3
Insurance broker name	HEALEY & ASSOCIATES INC

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

095805

Policy instance

Insurance contract or identification number	095805
Number of Individuals Covered	298
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $45,179
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,661,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,179
Insurance broker organization code?	3
Insurance broker name	HEALEY & ASSOCIATES INC

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

095806

Policy instance

Insurance contract or identification number	095806
Number of Individuals Covered	92
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $14,537
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $529,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,537
Insurance broker organization code?	3
Insurance broker name	HEALEY ASSOCIATES INC

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

056222

Policy instance

Insurance contract or identification number	056222
Number of Individuals Covered	31
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,276
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	HSA
Welfare Benefit Premiums Paid to Carrier	USD $133,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,276
Insurance broker organization code?	3
Insurance broker name	HEALEY & ASSOCIATES INC

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

095806

Policy instance

Insurance contract or identification number	095806
Number of Individuals Covered	95
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,930
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $453,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

056222

Policy instance

Insurance contract or identification number	056222
Number of Individuals Covered	73
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,169
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	HSA
Welfare Benefit Premiums Paid to Carrier	USD $333,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05573245

Policy instance

Insurance contract or identification number	TM05573245
Number of Individuals Covered	325
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,833
Welfare Benefit Premiums Paid to Carrier	USD $97,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

095805

Policy instance

Insurance contract or identification number	095805
Number of Individuals Covered	233
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $37,090
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,297,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

095805

Policy instance

Insurance contract or identification number	095805
Number of Individuals Covered	224
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $36,062
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,195,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

056222

Policy instance

Insurance contract or identification number	056222
Number of Individuals Covered	43
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $4,964
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	HSA
Welfare Benefit Premiums Paid to Carrier	USD $170,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

095806

Policy instance

Insurance contract or identification number	095806
Number of Individuals Covered	80
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $11,504
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $386,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	HUSSON UNIVERSITY
Employer identification number (EIN):	010271210
NAIC Classification:	611000