SISTERS OF ST. ANNE, INC. ANNA MARIA COLLEGE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE
401k plan membership statisitcs for SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE
Measure | Date | Value |
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2012 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2012 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-05-31 | No |
Was this plan covered by a fidelity bond | 2012-05-31 | No |
If this is an individual account plan, was there a blackout period | 2012-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2012-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2012-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2012-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2012-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2012-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-05-31 | No |
Did the plan have assets held for investment | 2012-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-05-31 | No |
2011 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2011 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-05-31 | No |
Was this plan covered by a fidelity bond | 2011-05-31 | No |
If this is an individual account plan, was there a blackout period | 2011-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2011-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2011-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2011-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2011-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2011-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-05-31 | No |
Did the plan have assets held for investment | 2011-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-05-31 | No |
2010 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2010 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-05-31 | No |
Was this plan covered by a fidelity bond | 2010-05-31 | No |
If this is an individual account plan, was there a blackout period | 2010-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2010-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2010-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2010-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2010-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2010-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-05-31 | No |
Did the plan have assets held for investment | 2010-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-05-31 | No |
2009 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2009 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2009-05-31 | No |
Was this plan covered by a fidelity bond | 2009-05-31 | No |
If this is an individual account plan, was there a blackout period | 2009-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2009-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2009-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2009-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2009-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2009-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2009-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2009-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2009-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2009-05-31 | No |
Did the plan have assets held for investment | 2009-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2009-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2009-05-31 | No |
2008 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2008 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2008-05-31 | No |
Was this plan covered by a fidelity bond | 2008-05-31 | No |
If this is an individual account plan, was there a blackout period | 2008-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2008-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2008-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2008-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2008-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2008-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2008-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2008-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2008-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2008-05-31 | No |
Did the plan have assets held for investment | 2008-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2008-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2008-05-31 | No |
2007 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2007 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2007-05-31 | No |
Was this plan covered by a fidelity bond | 2007-05-31 | No |
If this is an individual account plan, was there a blackout period | 2007-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2007-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2007-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2007-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2007-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2007-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2007-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2007-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2007-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2007-05-31 | No |
Did the plan have assets held for investment | 2007-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2007-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2007-05-31 | No |
2006 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2006 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2006-05-31 | No |
Was this plan covered by a fidelity bond | 2006-05-31 | No |
If this is an individual account plan, was there a blackout period | 2006-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2006-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2006-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2006-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2006-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2006-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2006-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2006-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2006-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2006-05-31 | No |
Did the plan have assets held for investment | 2006-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2006-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2006-05-31 | No |
2005 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2005 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2005-05-31 | No |
Was this plan covered by a fidelity bond | 2005-05-31 | No |
If this is an individual account plan, was there a blackout period | 2005-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2005-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2005-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2005-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2005-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2005-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2005-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2005-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2005-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2005-05-31 | No |
Did the plan have assets held for investment | 2005-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2005-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2005-05-31 | No |
2004 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2004 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2004-05-31 | No |
Was this plan covered by a fidelity bond | 2004-05-31 | No |
If this is an individual account plan, was there a blackout period | 2004-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2004-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2004-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2004-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2004-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2004-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2004-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2004-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2004-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2004-05-31 | No |
Did the plan have assets held for investment | 2004-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2004-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2004-05-31 | No |
2003 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2003 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2003-05-31 | No |
Was this plan covered by a fidelity bond | 2003-05-31 | No |
If this is an individual account plan, was there a blackout period | 2003-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2003-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2003-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2003-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2003-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2003-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2003-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2003-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2003-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2003-05-31 | No |
Did the plan have assets held for investment | 2003-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2003-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2003-05-31 | No |
2002 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2002 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2002-05-31 | No |
Was this plan covered by a fidelity bond | 2002-05-31 | No |
If this is an individual account plan, was there a blackout period | 2002-05-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2002-05-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2002-05-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2002-05-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2002-05-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2002-05-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2002-05-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2002-05-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2002-05-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2002-05-31 | No |
Did the plan have assets held for investment | 2002-05-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2002-05-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2002-05-31 | No |
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 158782 |
Policy instance | 5 |
Insurance contract or identification number | GL 158782 | Number of Individuals Covered | 144 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,081 | Total amount of fees paid to insurance company | USD $693 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $26,620 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,081 | Amount paid for insurance broker fees | 378 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 2 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 122 | Insurance policy start date | 2021-06-01 | Insurance policy end date | 2022-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Insurance broker organization code? | 3 |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 4 |
Insurance contract or identification number | 6792_2 | Number of Individuals Covered | 41 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $973 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,213 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $973 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025733 |
Policy instance | 1 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 53 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $770 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $10,559 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $770 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 129573 |
Policy instance | 6 |
Insurance contract or identification number | LTD 129573 | Number of Individuals Covered | 144 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,422 | Total amount of fees paid to insurance company | USD $603 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,813 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,422 | Amount paid for insurance broker fees | 329 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 207901 |
Policy instance | 7 |
Insurance contract or identification number | VAR 207901 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 186956 |
Policy instance | 8 |
Insurance contract or identification number | VG 186956 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 |
|
ACI SPECIALTY BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 10 |
Number of Individuals Covered | 135 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | OTHER | Welfare Benefit Premiums Paid to Carrier | USD $1,507 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 3 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 80 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $3,032 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $47,402 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,032 | Insurance broker organization code? | 3 |
|
NEIGHBORHOOD HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 11109 ) |
Policy contract number | ARAC100926008/9 |
Policy instance | 11 |
Insurance contract or identification number | ARAC100926008/9 | Number of Individuals Covered | 88 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $36,500 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $1,494,304 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,500 |
|
HR CONCEPTS, LLC (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 9 |
Number of Individuals Covered | 28 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,872 | Other welfare benefits provided | FSA BENEFITS AND COBRA ADMIN | Welfare Benefit Premiums Paid to Carrier | USD $44,875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1872 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 129573 |
Policy instance | 8 |
Insurance contract or identification number | LTD 129573 | Number of Individuals Covered | 132 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,945 | Total amount of fees paid to insurance company | USD $684 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,952 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,945 | Amount paid for insurance broker fees | 439 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025733 |
Policy instance | 1 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 41 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $640 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,823 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $640 | Insurance broker organization code? | 3 |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 2 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 122 | Insurance policy start date | 2020-06-01 | Insurance policy end date | 2021-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Insurance broker organization code? | 3 |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | C002230025C01 |
Policy instance | 4 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 12 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $1,472 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $71,069 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,472 | Insurance broker organization code? | 3 |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 5 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 86 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $2,906 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,505 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,906 | Insurance broker organization code? | 3 |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 6 |
Insurance contract or identification number | 6792_2 | Number of Individuals Covered | 34 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $834 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,648 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $834 | Insurance broker organization code? | 3 |
|
ACI SPECIALTY BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 12 |
Number of Individuals Covered | 135 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | OTHER | Welfare Benefit Premiums Paid to Carrier | USD $1,944 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HR CONCEPTS, LLC (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 11 |
Number of Individuals Covered | 25 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,350 | Other welfare benefits provided | FSA BENEFITS AND COBRA ADMIN | Welfare Benefit Premiums Paid to Carrier | USD $33,731 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1350 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 158782 |
Policy instance | 7 |
Insurance contract or identification number | GL 158782 | Number of Individuals Covered | 140 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,011 | Total amount of fees paid to insurance company | USD $747 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,215 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,011 | Amount paid for insurance broker fees | 480 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 207901 |
Policy instance | 9 |
Insurance contract or identification number | VAR 207901 | Number of Individuals Covered | 12 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $52 | Total amount of fees paid to insurance company | USD $13 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $347 | 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 | Amount paid for insurance broker fees | 8 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 186956 |
Policy instance | 10 |
Insurance contract or identification number | VG 186956 | Number of Individuals Covered | 12 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $457 | Total amount of fees paid to insurance company | USD $141 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $4,570 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $457 | Amount paid for insurance broker fees | 91 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | C002230025C01 |
Policy instance | 3 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 148 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $23,766 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $1,079,871 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,766 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 186956 |
Policy instance | 10 |
Insurance contract or identification number | VG 186956 | Number of Individuals Covered | 11 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $403 | Total amount of fees paid to insurance company | USD $284 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $4,028 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $403 | Amount paid for insurance broker fees | 155 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 207901 |
Policy instance | 9 |
Insurance contract or identification number | VAR 207901 | Number of Individuals Covered | 16 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $54 | Total amount of fees paid to insurance company | USD $33 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $362 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54 | Amount paid for insurance broker fees | 18 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 129573 |
Policy instance | 8 |
Insurance contract or identification number | LTD 129573 | Number of Individuals Covered | 128 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,610 | Total amount of fees paid to insurance company | USD $1,117 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,491 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,610 | Amount paid for insurance broker fees | 609 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 158782 |
Policy instance | 7 |
Insurance contract or identification number | GL 158782 | Number of Individuals Covered | 133 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,698 | Total amount of fees paid to insurance company | USD $1,247 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,326 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,698 | Amount paid for insurance broker fees | 680 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 6 |
Insurance contract or identification number | 6792_2 | Number of Individuals Covered | 32 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $890 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,979 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $890 | Insurance broker organization code? | 3 |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 5 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 75 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $2,712 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $39,565 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,712 | Insurance broker organization code? | 3 |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | C002230025C01 |
Policy instance | 4 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 11 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $2,619 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $106,785 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,619 | Insurance broker organization code? | 3 |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | C002230025C01 |
Policy instance | 3 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 130 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $29,498 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $1,218,873 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,498 | Insurance broker organization code? | 3 |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 2 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 122 | Insurance policy start date | 2019-06-01 | Insurance policy end date | 2020-05-31 | Total amount of commissions paid to insurance broker | USD $405 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $2,700 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $405 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025733 |
Policy instance | 1 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 34 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $598 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,969 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $598 | Insurance broker organization code? | 3 |
|
ACI SPECIALTY BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 12 |
Number of Individuals Covered | 135 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | OTHER | Welfare Benefit Premiums Paid to Carrier | USD $1,134 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HR CONCEPTS, LLC (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 11 |
Number of Individuals Covered | 19 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,277 | Other welfare benefits provided | FSA BENEFITS AND COBRA ADMIN | Welfare Benefit Premiums Paid to Carrier | USD $36,784 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1277 |
|
HR CONCEPTS, LLC (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 13 |
Number of Individuals Covered | 25 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,470 | Other welfare benefits provided | FSA BENEFITS AND COBRA ADMIN | Welfare Benefit Premiums Paid to Carrier | USD $72,321 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1470 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES |
|
E4 LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 11 |
Number of Individuals Covered | 220 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 186956 |
Policy instance | 10 |
Insurance contract or identification number | VG 186956 | Number of Individuals Covered | 15 | Insurance policy start date | 2018-11-01 | Insurance policy end date | 2019-10-21 | Total amount of commissions paid to insurance broker | USD $565 | Total amount of fees paid to insurance company | USD $275 | Other welfare benefits provided | VOLUNTARY GROUP TERM LIFE | Welfare Benefit Premiums Paid to Carrier | USD $5,649 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $565 | Amount paid for insurance broker fees | 275 | Additional information about fees paid to insurance broker | TOTAL ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 129573 |
Policy instance | 8 |
Insurance contract or identification number | LTD 129573 | Number of Individuals Covered | 119 | Insurance policy start date | 2018-11-01 | Insurance policy end date | 2019-10-21 | Total amount of commissions paid to insurance broker | USD $2,803 | Total amount of fees paid to insurance company | USD $757 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,527 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,803 | Amount paid for insurance broker fees | 757 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 207901 |
Policy instance | 9 |
Insurance contract or identification number | VAR 207901 | Number of Individuals Covered | 22 | Insurance policy start date | 2018-11-01 | Insurance policy end date | 2019-10-21 | Total amount of commissions paid to insurance broker | USD $98 | Total amount of fees paid to insurance company | USD $33 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $654 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $98 | Amount paid for insurance broker fees | 33 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 2 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 0 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Insurance broker organization code? | 3 |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 158782 |
Policy instance | 7 |
Insurance contract or identification number | GL 158782 | Number of Individuals Covered | 127 | Insurance policy start date | 2018-11-01 | Insurance policy end date | 2019-10-21 | Total amount of commissions paid to insurance broker | USD $1,914 | Total amount of fees paid to insurance company | USD $845 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $22,776 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,914 | Amount paid for insurance broker fees | 845 | Additional information about fees paid to insurance broker | ADMINISTRATIVE AND OTHER FEES | Insurance broker organization code? | 3 |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 6 |
Insurance contract or identification number | 6792_2 | Number of Individuals Covered | 38 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $955 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,189 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $955 |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 5 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 69 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $2,742 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,738 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,742 |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | C002230025C01 |
Policy instance | 4 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 14 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $2,216 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $85,566 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,216 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025733 |
Policy instance | 1 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 34 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $610 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,204 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $610 |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | C002230025C01 |
Policy instance | 3 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 118 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $22,172 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $886,001 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,172 | Insurance broker organization code? | 3 |
|
NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 ) |
Policy contract number | |
Policy instance | 12 |
Number of Individuals Covered | 200 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 30025733 |
Policy instance | 1 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 32 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $582 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,639 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
E4 LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 12 |
Number of Individuals Covered | 220 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | C002230025C01 |
Policy instance | 3 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 111 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $24,702 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $707,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | C002230025C01 |
Policy instance | 4 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 14 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $3,476 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $101,622 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 5 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 66 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $2,766 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $40,285 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 6 |
Insurance contract or identification number | 6792_2 | Number of Individuals Covered | 29 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $828 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,060 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 158782 |
Policy instance | 8 |
Insurance contract or identification number | GL 158782 | Number of Individuals Covered | 121 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-11-01 | Total amount of commissions paid to insurance broker | USD $1,554 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $16,981 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
E4 HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
Policy contract number | |
Policy instance | 10 |
Number of Individuals Covered | 220 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 207901 |
Policy instance | 11 |
Insurance contract or identification number | VAR 207901 | Number of Individuals Covered | 27 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-11-01 | Total amount of commissions paid to insurance broker | USD $106 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $709 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VG 186956 |
Policy instance | 7 |
Insurance contract or identification number | VG 186956 | Number of Individuals Covered | 18 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-11-01 | Total amount of commissions paid to insurance broker | USD $588 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,878 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 2 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 113 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-06-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | LTD 129573 |
Policy instance | 9 |
Insurance contract or identification number | LTD 129573 | Number of Individuals Covered | 113 | Insurance policy start date | 2017-11-01 | Insurance policy end date | 2018-11-01 | Total amount of commissions paid to insurance broker | USD $2,250 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,000 | 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 | 0841670000 |
Policy instance | 2 |
Insurance contract or identification number | 0841670000 | Number of Individuals Covered | 33 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $4,843 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $192,774 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,836 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841680000 |
Policy instance | 3 |
Insurance contract or identification number | 0841680000 | Number of Individuals Covered | 52 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $8,755 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $345,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,743 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841690000 |
Policy instance | 4 |
Insurance contract or identification number | 0841690000 | Number of Individuals Covered | 44 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $5,915 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $233,135 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,907 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 5 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 52 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $1,562 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,387 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,562 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 6 |
Insurance contract or identification number | 6792_2 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $600 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,679 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $600 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100018943 |
Policy instance | 7 |
Insurance contract or identification number | 40000100018943 | Number of Individuals Covered | 33 | Insurance policy start date | 2015-11-01 | Insurance policy end date | 2016-10-31 | Total amount of commissions paid to insurance broker | USD $917 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,174 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $917 | Additional information about fees paid to insurance broker | THE | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INS BRKRGE LLC |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00101972870000 |
Policy instance | 8 |
Insurance contract or identification number | 00101972870000 | Number of Individuals Covered | 129 | Insurance policy start date | 2015-11-01 | Insurance policy end date | 2016-10-31 | Total amount of commissions paid to insurance broker | USD $1,826 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $18,093 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,826 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INS BRKRGE LLC |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 ) |
Policy contract number | 30025733 |
Policy instance | 9 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 32 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $576 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $576 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00101972880000 |
Policy instance | 10 |
Insurance contract or identification number | 00101972880000 | Number of Individuals Covered | 113 | Insurance policy start date | 2015-11-01 | Insurance policy end date | 2016-10-31 | Total amount of commissions paid to insurance broker | USD $2,582 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,320 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,582 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INS BRKRGE LLC |
|
E4 WELLNESS, INC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 11 |
Number of Individuals Covered | 220 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | 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 | 0841700000 |
Policy instance | 12 |
Insurance contract or identification number | 0841700000 | Number of Individuals Covered | 7 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $747 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $29,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $746 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 1 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 113 | Insurance policy start date | 2016-06-01 | Insurance policy end date | 2017-06-01 | Total amount of commissions paid to insurance broker | USD $405 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $2,700 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $405 | Insurance broker organization code? | 3 | Insurance broker name | FRED C. CHURCH |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841680000 |
Policy instance | 4 |
Insurance contract or identification number | 0841680000 | Number of Individuals Covered | 52 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $8,755 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $345,100 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,743 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 00101972870000 |
Policy instance | 11 |
Insurance contract or identification number | 00101972870000 | Number of Individuals Covered | 129 | Insurance policy start date | 2015-11-01 | Insurance policy end date | 2016-10-31 | Total amount of commissions paid to insurance broker | USD $1,826 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $18,093 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,826 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INS BRKRGE LLC |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 ) |
Policy contract number | 30025733 |
Policy instance | 1 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 32 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $576 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $6,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $576 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 2 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 137 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2016-06-01 | Total amount of commissions paid to insurance broker | USD $143 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | TRAVEL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $950 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $143 | Insurance broker organization code? | 3 | Insurance broker name | FRED C. CHURCH |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841670000 |
Policy instance | 3 |
Insurance contract or identification number | 0841670000 | Number of Individuals Covered | 33 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $4,843 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $192,774 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,836 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100018943 |
Policy instance | 10 |
Insurance contract or identification number | 40000100018943 | Number of Individuals Covered | 33 | Insurance policy start date | 2015-11-01 | Insurance policy end date | 2016-10-31 | Total amount of commissions paid to insurance broker | USD $917 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOLUNTARY AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,174 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $917 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INS BRKRGE LLC |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 8 |
Insurance contract or identification number | 6792_2 | Number of Individuals Covered | 34 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $600 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,679 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $600 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841690000 |
Policy instance | 5 |
Insurance contract or identification number | 0841690000 | Number of Individuals Covered | 44 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $5,915 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $233,135 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,907 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841700000 |
Policy instance | 6 |
Insurance contract or identification number | 0841700000 | Number of Individuals Covered | 7 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $747 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $29,450 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $746 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 7 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 52 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $1,562 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,387 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,562 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
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E4 WELLNESS, INC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 9 |
Number of Individuals Covered | 220 | Insurance policy start date | 2015-06-01 | Insurance policy end date | 2016-05-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EAP/WELLNESS | Welfare Benefit Premiums Paid to Carrier | USD $4,500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001019728800000 |
Policy instance | 12 |
Insurance contract or identification number | 001019728800000 | Number of Individuals Covered | 113 | Insurance policy start date | 2015-11-01 | Insurance policy end date | 2016-10-31 | Total amount of commissions paid to insurance broker | USD $2,582 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $18,320 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,582 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INS BRKRGE LLC |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841670000 |
Policy instance | 4 |
Insurance contract or identification number | 0841670000 | Number of Individuals Covered | 38 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $6,329 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $244,637 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,332 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841680000 |
Policy instance | 5 |
Insurance contract or identification number | 0841680000 | Number of Individuals Covered | 58 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $8,375 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $326,260 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,409 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841690000 |
Policy instance | 6 |
Insurance contract or identification number | 0841690000 | Number of Individuals Covered | 43 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $5,696 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $221,885 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,999 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841700000 |
Policy instance | 7 |
Insurance contract or identification number | 0841700000 | Number of Individuals Covered | 5 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $604 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $23,500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $318 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
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ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_1 |
Policy instance | 8 |
Insurance contract or identification number | 6792_1 | Number of Individuals Covered | 50 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $2,212 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $29,104 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,212 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 101 | Insurance policy end date | 2015-06-01 | Total amount of commissions paid to insurance broker | USD $1,952 | 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 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE, VOL DEP LIFE, VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $16,078 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,952 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INSURANCE |
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ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
Policy contract number | 6792_2 |
Policy instance | 9 |
Insurance contract or identification number | 6792_2 | Number of Individuals Covered | 39 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $955 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $12,559 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $955 | Insurance broker organization code? | 3 | Insurance broker name | RSC INSURANCE BROKERAGE, INC. |
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TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
Policy contract number | 1911 |
Policy instance | 10 |
Insurance contract or identification number | 1911 | Number of Individuals Covered | 1 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $100 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $100 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER POWERS |
|
E4 WELLNESS, INC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 11 |
Number of Individuals Covered | 220 | Insurance policy start date | 2014-06-01 | Insurance policy end date | 2015-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Other welfare benefits provided | EAP/WELLNESS | Welfare Benefit Premiums Paid to Carrier | USD $4,500 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 3 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 137 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2016-06-01 | Total amount of commissions paid to insurance broker | USD $143 | 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 | Other welfare benefits provided | TRAVEL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $950 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $143 | Insurance broker organization code? | 3 | Insurance broker name | FRED C. CHURCH |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 ) |
Policy contract number | 30025733 |
Policy instance | 2 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 33 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $524 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $5,482 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $355 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER POWERS |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 ) |
Policy contract number | 30025733 |
Policy instance | 3 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 24 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $391 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,909 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $254 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER POWERS |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 4 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 137 | Insurance policy start date | 2013-06-01 | Insurance policy end date | 2016-06-01 | Total amount of commissions paid to insurance broker | USD $143 | 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 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $950 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $143 | Insurance broker organization code? | 3 | Insurance broker name | FRED C. CHURCH |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841690000 |
Policy instance | 7 |
Insurance contract or identification number | 0841690000 | Number of Individuals Covered | 37 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $7,768 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $193,975 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,768 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841700000 |
Policy instance | 8 |
Insurance contract or identification number | 0841700000 | Number of Individuals Covered | 11 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $1,749 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $43,670 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,749 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 2 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 50 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $2,756 | Total amount of fees paid to insurance company | USD $1,995 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $48,078 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,406 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1995 | Additional information about fees paid to insurance broker | MISCELLANEOUS FEES | Insurance broker name | BULFINCH GROUP INSURANCE AGENCY, LL |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 111 | Insurance policy end date | 2014-06-01 | Total amount of commissions paid to insurance broker | USD $4,956 | 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 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE, VOL DEP LIFE | Welfare Benefit Premiums Paid to Carrier | USD $42,896 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,956 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INSURANCE |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841670000 |
Policy instance | 5 |
Insurance contract or identification number | 0841670000 | Number of Individuals Covered | 51 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $11,631 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $290,439 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,631 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
Policy contract number | 0841680000 |
Policy instance | 6 |
Insurance contract or identification number | 0841680000 | Number of Individuals Covered | 59 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $15,008 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $374,767 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,008 | Insurance broker organization code? | 3 | Insurance broker name | MICHAEL TSOTSIS |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | C002230025C01 |
Policy instance | 4 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 13 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $2,289 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $82,132 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,488 | Insurance broker name | CHRISTOPHER POWERS |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | C002230025C01 |
Policy instance | 3 |
Insurance contract or identification number | C002230025C01 | Number of Individuals Covered | 156 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $23,861 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $866,710 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,509 | Insurance broker organization code? | 3 | Insurance broker name | CHRISTOPHER POWERS |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 2 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 54 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $2,821 | Total amount of fees paid to insurance company | USD $2,317 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $51,076 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,766 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2317 | Additional information about fees paid to insurance broker | MISCELLANEOUS FEES | Insurance broker name | ROBERT FINE |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 6 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 137 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2013-01-01 | Total amount of commissions paid to insurance broker | USD $143 | 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 | Other welfare benefits provided | TRAVEL AD&D | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $143 | Insurance broker name | FRED C. CHURCH |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 111 | Insurance policy start date | 2012-06-01 | Insurance policy end date | 2013-06-01 | Total amount of commissions paid to insurance broker | USD $4,716 | 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 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | BASIC AD&D,VOL LIFE/DEP LIFE/AD&D | Welfare Benefit Premiums Paid to Carrier | USD $38,054 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,716 | Insurance broker organization code? | 3 | Insurance broker name | AISLING PARTNERS INSURANCE |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 ) |
Policy contract number | 30025733 |
Policy instance | 5 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 25 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $396 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,957 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $257 | Insurance broker name | CHRISTOPHER POWERS |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU3586763 |
Policy instance | 6 |
Insurance contract or identification number | GTU3586763 | Number of Individuals Covered | 137 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2013-01-01 | Total amount of commissions paid to insurance broker | USD $143 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 2 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 55 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $2,786 | Total amount of fees paid to insurance company | USD $3,566 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $49,240 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 107 | Insurance policy end date | 2012-06-01 | Total amount of commissions paid to insurance broker | USD $3,947 | 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 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE, VOL DEP LIFE, VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $36,494 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 3 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 151 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $21,213 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $854,314 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | 9982520 |
Policy instance | 4 |
Insurance contract or identification number | 9982520 | Number of Individuals Covered | 4 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $1,688 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $33,620 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 ) |
Policy contract number | 30025733 |
Policy instance | 5 |
Insurance contract or identification number | 30025733 | Number of Individuals Covered | 15 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-05-31 | Total amount of commissions paid to insurance broker | USD $183 | 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 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,825 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 124 | Insurance policy end date | 2011-06-01 | Total amount of commissions paid to insurance broker | USD $4,377 | 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 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE, VOL DEP LIFE, VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $41,024 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 2 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 51 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $2,644 | Total amount of fees paid to insurance company | USD $2,907 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $43,665 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 3 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 175 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $36,813 | Total amount of fees paid to insurance company | USD $99,295 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $974,192 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | GTU 3586763 |
Policy instance | 5 |
Insurance contract or identification number | GTU 3586763 | Number of Individuals Covered | 137 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2013-01-01 | Total amount of commissions paid to insurance broker | USD $143 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | 9982520 |
Policy instance | 4 |
Insurance contract or identification number | 9982520 | Number of Individuals Covered | 8 | Insurance policy start date | 2010-06-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $705 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $42,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 3 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 164 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $27,050 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $918,324 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 2 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 51 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $2,549 | Total amount of fees paid to insurance company | USD $2,642 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $39,952 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 126 | Insurance policy end date | 2010-06-01 | Total amount of commissions paid to insurance broker | USD $3,941 | 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 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE, VOL DEP LIFE,VOL AD&D | Welfare Benefit Premiums Paid to Carrier | USD $35,907 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
Policy contract number | 9982520 |
Policy instance | 4 |
Insurance contract or identification number | 9982520 | Number of Individuals Covered | 5 | Insurance policy start date | 2009-06-01 | Insurance policy end date | 2010-05-31 | Total amount of commissions paid to insurance broker | USD $1,406 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $46,896 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 3 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 82 | Insurance policy start date | 2008-06-01 | Insurance policy end date | 2009-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 2 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 47 | Insurance policy start date | 2008-06-01 | Insurance policy end date | 2009-05-31 | Total amount of commissions paid to insurance broker | USD $2,441 | Total amount of fees paid to insurance company | USD $2,435 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $35,714 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 106 | Insurance policy end date | 2009-06-01 | Total amount of commissions paid to insurance broker | USD $2,715 | 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 | 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 $25,325 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
TUFTS HEALTH PLAN OF NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 2 | Insurance policy start date | 2007-06-01 | Insurance policy end date | 2008-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
Policy contract number | 454-5328-00 |
Policy instance | 1 |
Insurance contract or identification number | 454-5328-00 | Number of Individuals Covered | 109 | Insurance policy end date | 2008-05-31 | Total amount of commissions paid to insurance broker | USD $3,322 | 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 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL LIFE, VOL DEP LIFE | Welfare Benefit Premiums Paid to Carrier | USD $25,501 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 3 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 66 | Insurance policy start date | 2007-06-01 | Insurance policy end date | 2008-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 2 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 42 | Insurance policy start date | 2007-06-01 | Insurance policy end date | 2008-05-31 | Total amount of commissions paid to insurance broker | USD $2,483 | Total amount of fees paid to insurance company | USD $2,754 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $37,346 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 3 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 49 | Insurance policy start date | 2006-06-01 | Insurance policy end date | 2007-05-31 | Total amount of commissions paid to insurance broker | USD $2,440 | Total amount of fees paid to insurance company | USD $2,436 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $35,696 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 139026 |
Policy instance | 2 |
Insurance contract or identification number | 139026 | Number of Individuals Covered | 110 | Insurance policy start date | 2006-06-01 | Insurance policy end date | 2007-05-31 | Total amount of commissions paid to insurance broker | USD $1,649 | 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 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 139026 |
Policy instance | 1 |
Insurance contract or identification number | 139026 | Number of Individuals Covered | 115 | Insurance policy start date | 2006-06-01 | Insurance policy end date | 2007-05-31 | Total amount of commissions paid to insurance broker | USD $1,282 | 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 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
TUFTS HEALTH PLAN OF NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 2 | Insurance policy start date | 2006-06-01 | Insurance policy end date | 2007-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 4 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 78 | Insurance policy start date | 2006-06-01 | Insurance policy end date | 2007-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 139026 |
Policy instance | 1 |
Insurance contract or identification number | 139026 | Number of Individuals Covered | 107 | Insurance policy start date | 2005-06-01 | Insurance policy end date | 2006-05-31 | Total amount of commissions paid to insurance broker | USD $1,236 | Total amount of fees paid to insurance company | USD $218 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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TUFTS HEALTH PLAN OF NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 3 | Insurance policy start date | 2005-06-01 | Insurance policy end date | 2006-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 4 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 80 | Insurance policy start date | 2005-06-01 | Insurance policy end date | 2006-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 3 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 46 | Insurance policy start date | 2005-06-01 | Insurance policy end date | 2006-05-31 | Total amount of commissions paid to insurance broker | USD $2,430 | Total amount of fees paid to insurance company | USD $1,662 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $34,864 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 139026 |
Policy instance | 2 |
Insurance contract or identification number | 139026 | Number of Individuals Covered | 104 | Insurance policy start date | 2005-06-01 | Insurance policy end date | 2006-05-31 | Total amount of commissions paid to insurance broker | USD $1,574 | Total amount of fees paid to insurance company | USD $193 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 4 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 44 | Insurance policy start date | 2004-06-01 | Insurance policy end date | 2005-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 |
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TUFTS HEALTH PLAN OF NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 4 | Insurance policy start date | 2004-06-01 | Insurance policy end date | 2005-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 44054 |
Policy instance | 3 |
Insurance contract or identification number | 44054 | Number of Individuals Covered | 73 | Insurance policy start date | 2004-06-01 | Insurance policy end date | 2005-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 201621 |
Policy instance | 2 |
Insurance contract or identification number | VAR 201621 | Number of Individuals Covered | 55 | Insurance policy end date | 2005-05-31 | Total amount of commissions paid to insurance broker | USD $64 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $639 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 131652 |
Policy instance | 1 |
Insurance contract or identification number | GL 131652 | Number of Individuals Covered | 55 | Insurance policy end date | 2005-05-31 | Total amount of commissions paid to insurance broker | USD $939 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,513 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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TUFTS HEALTH PLAN OF NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 9 | Insurance policy start date | 2003-06-01 | Insurance policy end date | 2004-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 4 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 47 | Insurance policy start date | 2003-06-01 | Insurance policy end date | 2004-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 3 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 66 | Insurance policy start date | 2003-06-01 | Insurance policy end date | 2004-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 201621 |
Policy instance | 2 |
Insurance contract or identification number | VAR 201621 | Number of Individuals Covered | 50 | Insurance policy start date | 2003-06-01 | Insurance policy end date | 2004-05-31 | Total amount of commissions paid to insurance broker | USD $67 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISBURSEMENT | Welfare Benefit Premiums Paid to Carrier | USD $675 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 131652 |
Policy instance | 1 |
Insurance contract or identification number | GL 131652 | Number of Individuals Covered | 50 | Insurance policy start date | 2003-06-01 | Insurance policy end date | 2004-05-31 | Total amount of commissions paid to insurance broker | USD $1,022 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,146 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL 131652 |
Policy instance | 1 |
Insurance contract or identification number | GL 131652 | Number of Individuals Covered | 53 | Insurance policy end date | 2003-05-31 | Total amount of commissions paid to insurance broker | USD $1,108 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,683 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 3 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 64 | Insurance policy start date | 2002-06-01 | Insurance policy end date | 2003-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00369124 |
Policy instance | 4 |
Insurance contract or identification number | 00369124 | Number of Individuals Covered | 46 | Insurance policy start date | 2002-06-01 | Insurance policy end date | 2003-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 |
|
TUFTS HEALTH PLAN OF NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 62419 ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 10 | Insurance policy start date | 2002-06-01 | Insurance policy end date | 2003-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 201621 |
Policy instance | 2 |
Insurance contract or identification number | VAR 201621 | Number of Individuals Covered | 53 | Insurance policy end date | 2003-05-31 | Total amount of commissions paid to insurance broker | USD $76 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $760 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CIGNA HEALTHCARE OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | |
Policy instance | 5 |
Number of Individuals Covered | 51 | Insurance policy start date | 2001-06-01 | Insurance policy end date | 2002-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
Policy contract number | 4450424 |
Policy instance | 4 |
Insurance contract or identification number | 4450424 | Number of Individuals Covered | 44 | Insurance policy start date | 2001-06-01 | Insurance policy end date | 2002-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | |
Policy instance | 3 |
Number of Individuals Covered | 15 | Insurance policy start date | 2001-06-01 | Insurance policy end date | 2002-05-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | VAR 201621 |
Policy instance | 2 |
Insurance contract or identification number | VAR 201621 | Number of Individuals Covered | 51 | Insurance policy end date | 2002-05-31 | Total amount of commissions paid to insurance broker | USD $6 | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $56 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
Policy contract number | GL131652 |
Policy instance | 1 |
Insurance contract or identification number | GL131652 | Number of Individuals Covered | 51 | Insurance policy end date | 2002-05-31 | Total amount of commissions paid to insurance broker | USD $110 | 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 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,000 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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