401k Plan data: HUSSON UNIVERSITY WELFARE BENEFIT PLAN plan

HUSSON UNIVERSITY WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	HUSSON UNIVERSITY WELFARE BENEFIT PLAN
Plan identification number	504

HUSSON UNIVERSITY WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover

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 UNIVERSITY WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2017-02-01

Plan Statistics for HUSSON UNIVERSITY WELFARE BENEFIT PLAN

401k plan membership statisitcs for HUSSON UNIVERSITY WELFARE BENEFIT PLAN

Measure Date Value
2017: HUSSON UNIVERSITY WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-02-01 406
Total number of active participants reported on line 7a of the Form 5500 2017-02-01 434
Number of retired or separated participants receiving benefits 2017-02-01 5
Total of all active and inactive participants 2017-02-01 439

Measure	Date	Value
2017: HUSSON UNIVERSITY WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-02-01	406
Total number of active participants reported on line 7a of the Form 5500	2017-02-01	434
Number of retired or separated participants receiving benefits	2017-02-01	5
Total of all active and inactive participants	2017-02-01	439

Form 5500 Responses for HUSSON UNIVERSITY WELFARE BENEFIT PLAN

2017: HUSSON UNIVERSITY WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-02-01	Type of plan entity	Single employer plan
2017-02-01	First time form 5500 has been submitted	Yes
2017-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

408206

Policy instance

Insurance contract or identification number	408206
Number of Individuals Covered	387
Insurance policy start date	2017-02-07
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,081
Total amount of fees paid to insurance company	USD $4,450
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $223,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,081
Amount paid for insurance broker fees	4450
Insurance broker organization code?	3
Insurance broker name	CROSS INSURANCE

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

Policy contract number

000061408

Policy instance

Insurance contract or identification number	000061408
Number of Individuals Covered	436
Insurance policy start date	2017-02-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,458
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,458
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	179
Insurance policy start date	2017-02-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,766
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 $826,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,725
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	338
Insurance policy start date	2017-02-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $27,295
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,096,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,192
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	83
Insurance policy start date	2017-02-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,831
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $447,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,809
Insurance broker organization code?	3
Insurance broker name	HOLDEN AGENCY

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