401k Plan data: FLORENCE SAVINGS BANK SECTION 125 PLAN plan

FLORENCE SAVINGS BANK SECTION 125 PLAN 401k Plan overview

Plan Name	FLORENCE SAVINGS BANK SECTION 125 PLAN
Plan identification number	501

FLORENCE SAVINGS BANK SECTION 125 PLAN Benefits

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

401k Sponsoring company profile

FLORENCE BANK has sponsored the creation of one or more 401k plans.

Company Name: FLORENCE BANK

Employer identification number (EIN): 041332530

NAIC Classification: 522120
NAIC Description: Savings Institutions

Additional information about FLORENCE BANK

Jurisdiction of Incorporation: Commonwealth of Massachusetts Corporations Division

Incorporation Date:

Company Identification Number: 041332530

More information about FLORENCE BANK

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FLORENCE SAVINGS BANK SECTION 125 PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 JENNA RAHILLY 2023-05-24 SARAH DARLING 2023-05-26
501 2021-01-01 JENNA RAHILLY 2022-06-16 SARAH DARLING 2022-06-16
501 2020-01-01 SARAH DARLING 2021-06-16 SARAH DARLING 2021-06-16
501 2019-01-01 SARAH DARLING 2020-07-27 SARAH DARLING 2020-07-27
501 2018-01-01
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 HARRY KALAJIAN HARRY KALAJIAN 2013-06-25
501 2011-01-01 HARRY KALAJIAN HARRY KALAJIAN 2012-07-17
501 2010-01-01 HARRY KALAJIAN HARRY KALAJIAN 2011-07-19
501 2009-01-01 DIANE GOULD DIANE GOULD 2010-07-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	JENNA RAHILLY	2023-05-24	SARAH DARLING	2023-05-26
501	2021-01-01	JENNA RAHILLY	2022-06-16	SARAH DARLING	2022-06-16
501	2020-01-01	SARAH DARLING	2021-06-16	SARAH DARLING	2021-06-16
501	2019-01-01	SARAH DARLING	2020-07-27	SARAH DARLING	2020-07-27
501	2018-01-01
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	HARRY KALAJIAN		HARRY KALAJIAN	2013-06-25
501	2011-01-01	HARRY KALAJIAN		HARRY KALAJIAN	2012-07-17
501	2010-01-01	HARRY KALAJIAN		HARRY KALAJIAN	2011-07-19
501	2009-01-01	DIANE GOULD		DIANE GOULD	2010-07-22

Plan Statistics for FLORENCE SAVINGS BANK SECTION 125 PLAN

401k plan membership statisitcs for FLORENCE SAVINGS BANK SECTION 125 PLAN

Measure Date Value
2022: FLORENCE SAVINGS BANK SECTION 125 PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 321
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 312
Total of all active and inactive participants 2022-01-01 312
2021: FLORENCE SAVINGS BANK SECTION 125 PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 316
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 321
Total of all active and inactive participants 2021-01-01 321
2020: FLORENCE SAVINGS BANK SECTION 125 PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 336
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 316
Total of all active and inactive participants 2020-01-01 316
2019: FLORENCE SAVINGS BANK SECTION 125 PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 366
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 336
Total of all active and inactive participants 2019-01-01 336
2018: FLORENCE SAVINGS BANK SECTION 125 PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 372
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 366
Total of all active and inactive participants 2018-01-01 366
2017: FLORENCE SAVINGS BANK SECTION 125 PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 364
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 372
Total of all active and inactive participants 2017-01-01 372
2016: FLORENCE SAVINGS BANK SECTION 125 PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 375
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 364
Total of all active and inactive participants 2016-01-01 364
Total participants 2016-01-01 364
2015: FLORENCE SAVINGS BANK SECTION 125 PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 377
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 375
Total of all active and inactive participants 2015-01-01 375
Total participants 2015-01-01 375
2014: FLORENCE SAVINGS BANK SECTION 125 PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 376
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 377
Total of all active and inactive participants 2014-01-01 377
Total participants 2014-01-01 377
2013: FLORENCE SAVINGS BANK SECTION 125 PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 376
Total of all active and inactive participants 2013-01-01 376
Total participants 2013-01-01 376
2012: FLORENCE SAVINGS BANK SECTION 125 PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 204
Total of all active and inactive participants 2012-01-01 204
Total participants 2012-01-01 204
2011: FLORENCE SAVINGS BANK SECTION 125 PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 199
Total of all active and inactive participants 2011-01-01 199
Total participants 2011-01-01 199
2010: FLORENCE SAVINGS BANK SECTION 125 PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 193
Total of all active and inactive participants 2010-01-01 193
Total participants 2010-01-01 193
2009: FLORENCE SAVINGS BANK SECTION 125 PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 203
Total of all active and inactive participants 2009-01-01 203
Total participants 2009-01-01 203

Measure	Date	Value
2022: FLORENCE SAVINGS BANK SECTION 125 PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	321
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	312
Total of all active and inactive participants	2022-01-01	312
2021: FLORENCE SAVINGS BANK SECTION 125 PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	316
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	321
Total of all active and inactive participants	2021-01-01	321
2020: FLORENCE SAVINGS BANK SECTION 125 PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	336
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	316
Total of all active and inactive participants	2020-01-01	316
2019: FLORENCE SAVINGS BANK SECTION 125 PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	366
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	336
Total of all active and inactive participants	2019-01-01	336
2018: FLORENCE SAVINGS BANK SECTION 125 PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	372
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	366
Total of all active and inactive participants	2018-01-01	366
2017: FLORENCE SAVINGS BANK SECTION 125 PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	364
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	372
Total of all active and inactive participants	2017-01-01	372
2016: FLORENCE SAVINGS BANK SECTION 125 PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	375
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	364
Total of all active and inactive participants	2016-01-01	364
Total participants	2016-01-01	364
2015: FLORENCE SAVINGS BANK SECTION 125 PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	377
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	375
Total of all active and inactive participants	2015-01-01	375
Total participants	2015-01-01	375
2014: FLORENCE SAVINGS BANK SECTION 125 PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	376
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	377
Total of all active and inactive participants	2014-01-01	377
Total participants	2014-01-01	377
2013: FLORENCE SAVINGS BANK SECTION 125 PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	376
Total of all active and inactive participants	2013-01-01	376
Total participants	2013-01-01	376
2012: FLORENCE SAVINGS BANK SECTION 125 PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	204
Total of all active and inactive participants	2012-01-01	204
Total participants	2012-01-01	204
2011: FLORENCE SAVINGS BANK SECTION 125 PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	199
Total of all active and inactive participants	2011-01-01	199
Total participants	2011-01-01	199
2010: FLORENCE SAVINGS BANK SECTION 125 PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	193
Total of all active and inactive participants	2010-01-01	193
Total participants	2010-01-01	193
2009: FLORENCE SAVINGS BANK SECTION 125 PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	203
Total of all active and inactive participants	2009-01-01	203
Total participants	2009-01-01	203

Form 5500 Responses for FLORENCE SAVINGS BANK SECTION 125 PLAN

2022: FLORENCE SAVINGS BANK SECTION 125 PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: FLORENCE SAVINGS BANK SECTION 125 PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: FLORENCE SAVINGS BANK SECTION 125 PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: FLORENCE SAVINGS BANK SECTION 125 PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: FLORENCE SAVINGS BANK SECTION 125 PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: FLORENCE SAVINGS BANK SECTION 125 PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: FLORENCE SAVINGS BANK SECTION 125 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: FLORENCE SAVINGS BANK SECTION 125 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: FLORENCE SAVINGS BANK SECTION 125 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: FLORENCE SAVINGS BANK SECTION 125 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: FLORENCE SAVINGS BANK SECTION 125 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: FLORENCE SAVINGS BANK SECTION 125 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: FLORENCE SAVINGS BANK SECTION 125 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: FLORENCE SAVINGS BANK SECTION 125 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

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

245726

Policy instance

Insurance contract or identification number	245726
Number of Individuals Covered	206
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,950
Total amount of fees paid to insurance company	USD $5,980
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $138,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,950
Insurance broker organization code?	3
Amount paid for insurance broker fees	5980
Additional information about fees paid to insurance broker	BONUS

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	312
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,545
Total amount of fees paid to insurance company	USD $954
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $171,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,545
Amount paid for insurance broker fees	954
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	139
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $38,211
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,498,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,211
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	141
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $39,879
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,518,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,879
Insurance broker organization code?	3

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	321
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,125
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,125
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

245726

Policy instance

Insurance contract or identification number	245726
Number of Individuals Covered	201
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,980
Total amount of fees paid to insurance company	USD $4,872
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $132,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,724
Amount paid for insurance broker fees	4872
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

245726

Policy instance

Insurance contract or identification number	245726
Number of Individuals Covered	191
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,178
Total amount of fees paid to insurance company	USD $5,740
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $131,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,178
Amount paid for insurance broker fees	5740
Additional information about fees paid to insurance broker	BONUSES PAID
Insurance broker organization code?	3

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	316
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,394
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $177,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,394
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	149
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $46,674
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,606,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,674
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	150
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $52,888
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,596,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,888

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	336
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,136
Total amount of fees paid to insurance company	USD $1,521
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $183,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,136
Amount paid for insurance broker fees	1521
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

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

Policy contract number

586765

Policy instance

Insurance contract or identification number	586765
Number of Individuals Covered	21
Insurance policy start date	2018-11-01
Insurance policy end date	2019-11-01
Total amount of commissions paid to insurance broker	USD $5,773
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $39,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,773
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

245726

Policy instance

Insurance contract or identification number	245726
Number of Individuals Covered	213
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,932
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $119,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,819
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

245726

Policy instance

Insurance contract or identification number	245726
Number of Individuals Covered	214
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,369
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $111,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,118
Insurance broker organization code?	3

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

Policy contract number

586765

Policy instance

Insurance contract or identification number	586765
Number of Individuals Covered	9
Insurance policy start date	2017-11-01
Insurance policy end date	2018-11-01
Total amount of commissions paid to insurance broker	USD $6,043
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $39,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,043
Insurance broker organization code?	3

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	366
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,302
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $188,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,723
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	150
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $66,495
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,624,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,495
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

245726

Policy instance

Insurance contract or identification number	245726
Number of Individuals Covered	199
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,105
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $96,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,105
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC INSURANCE AGENCY

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

Policy contract number

586765

Policy instance

Insurance contract or identification number	586765
Number of Individuals Covered	9
Insurance policy start date	2016-11-01
Insurance policy end date	2017-11-01
Total amount of commissions paid to insurance broker	USD $6,068
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $40,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,068
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC INSURANCE AGENCY

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	372
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,605
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $203,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,605
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GRP INC INS AGCY

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	152
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $58,085
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,700,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,085
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	375
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,889
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $171,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,889
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GRP. INC. INS. AGCY.

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	170
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $57,424
Total amount of fees paid to insurance company	USD $6,526
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,465,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,424
Amount paid for insurance broker fees	6526
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

246-6961-00

Policy instance

Insurance contract or identification number	246-6961-00
Number of Individuals Covered	206
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,147
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE; AD&D
Welfare Benefit Premiums Paid to Carrier	USD $84,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,147
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC IN

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

Policy contract number

586765

Policy instance

Insurance contract or identification number	586765
Number of Individuals Covered	10
Insurance policy start date	2014-11-01
Insurance policy end date	2015-11-01
Total amount of commissions paid to insurance broker	USD $7,184
Other welfare benefits provided	GROUP LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $47,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,184
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	377
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,971
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,971
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GRP. INC. INS. AGCY.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

246-6961-00

Policy instance

Insurance contract or identification number	246-6961-00
Number of Individuals Covered	196
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,636
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE; AD&D
Welfare Benefit Premiums Paid to Carrier	USD $75,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,636
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC IN

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	192
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $49,894
Total amount of fees paid to insurance company	USD $13,839
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,428,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,894
Amount paid for insurance broker fees	13839
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	175
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $52,577
Total amount of fees paid to insurance company	USD $23,567
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,427,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,577
Amount paid for insurance broker fees	23567
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

246-6961-00

Policy instance

Insurance contract or identification number	246-6961-00
Number of Individuals Covered	204
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $17,242
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE; AD&D
Welfare Benefit Premiums Paid to Carrier	USD $70,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,242
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC IN

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

012754

Policy instance

Insurance contract or identification number	012754
Number of Individuals Covered	376
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,840
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $160,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,840
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GRP. INC. INS. AGCY.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

246-6961-00

Policy instance

Insurance contract or identification number	246-6961-00
Number of Individuals Covered	204
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE; AD&D
Welfare Benefit Premiums Paid to Carrier	USD $67,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	185
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $53,954
Total amount of fees paid to insurance company	USD $20,436
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,579,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,954
Amount paid for insurance broker fees	20436
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

246-6961-00

Policy instance

Insurance contract or identification number	246-6961-00
Number of Individuals Covered	199
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEPEND LIFE; AD&D
Welfare Benefit Premiums Paid to Carrier	USD $65,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )

Policy contract number

114812

Policy instance

Insurance contract or identification number	114812
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $32
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	169
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $54,189
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,384,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

586765

Policy instance

Insurance contract or identification number	586765
Number of Individuals Covered	15
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,051
Total amount of fees paid to insurance company	USD $268
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,500
Commission paid to Insurance Broker	USD $5,051
Insurance broker organization code?	3
Amount paid for insurance broker fees	268
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	COLONIAL LIFE & ACCIDENT INS

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

113810

Policy instance

Insurance contract or identification number	113810
Number of Individuals Covered	162
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $85,116
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,359,337
Commission paid to Insurance Broker	USD $85,116
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC

UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 )

Policy contract number

114812

Policy instance

Insurance contract or identification number	114812
Number of Individuals Covered	193
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $380
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,512
Commission paid to Insurance Broker	USD $380
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC.

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

Policy contract number

631421

Policy instance

Insurance contract or identification number	631421
Number of Individuals Covered	193
Insurance policy start date	2009-08-01
Insurance policy end date	2010-07-31
Total amount of commissions paid to insurance broker	USD $3,470
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $3,470
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC.

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

Policy contract number

631421

Policy instance

Insurance contract or identification number	631421
Number of Individuals Covered	190
Insurance policy start date	2009-08-01
Insurance policy end date	2010-07-31
Total amount of commissions paid to insurance broker	USD $5,030
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $5,030
Insurance broker organization code?	3
Insurance broker name	GAUDREAU GROUP INC.

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Company Name:	FLORENCE BANK
Employer identification number (EIN):	041332530
NAIC Classification:	522120
NAIC Description:	Savings Institutions

Jurisdiction of Incorporation:	Commonwealth of Massachusetts Corporations Division
Incorporation Date:
Company Identification Number:	041332530