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SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 401k Plan overview

Plan NameSISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE
Plan identification number 502

SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SISTERS OF ST. ANNE, INC. ANNA MARIA COLLEGE has sponsored the creation of one or more 401k plans.

Company Name:SISTERS OF ST. ANNE, INC. ANNA MARIA COLLEGE
Employer identification number (EIN):042002060
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-07-01MICHAEL MIERS2023-03-10 CORINA HENDEA2023-03-10
5022020-07-01MICHAEL MIERS2022-04-13 CORINA HENDEA2022-04-13
5022019-07-01ALEX MOWATT2021-04-05 JOELLEN ANDREWS2021-04-05
5022018-07-01ALEX MOWATT2020-03-18 JOELLEN ANDREWS2020-03-18
5022017-07-01
5022016-07-01
5022016-06-01
5022015-06-01
5022014-06-01
5022013-06-01
5022012-06-01LISA DRISCOLL
5022011-06-01LISA DRISCOLL
5022010-06-01LISA DRISCOLL
5022009-06-01JAN RUGGIERI
5022008-06-01JAN RUGGIERI
5022007-06-01JAN RUGGIERI
5022006-06-01JAN RUGGIERI
5022005-06-01JAN RUGGIERI
5022004-06-01JAN RUGGIERI
5022003-06-01JAN RUGGIERI
5022002-06-01JAN RUGGIERI
5022001-06-01JAN RUGGIERI

Plan Statistics for 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
2021: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2021 401k membership
Total participants, beginning-of-year2021-07-01220
Total number of active participants reported on line 7a of the Form 55002021-07-01220
Total of all active and inactive participants2021-07-01220
2020: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2020 401k membership
Total participants, beginning-of-year2020-07-01220
Total number of active participants reported on line 7a of the Form 55002020-07-01220
Total of all active and inactive participants2020-07-01220
2019: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2019 401k membership
Total participants, beginning-of-year2019-07-01220
Total number of active participants reported on line 7a of the Form 55002019-07-01220
Total of all active and inactive participants2019-07-01220
2018: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2018 401k membership
Total participants, beginning-of-year2018-07-01220
Total number of active participants reported on line 7a of the Form 55002018-07-01220
Total of all active and inactive participants2018-07-01220
2017: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2017 401k membership
Total participants, beginning-of-year2017-07-01220
Total number of active participants reported on line 7a of the Form 55002017-07-01220
Total of all active and inactive participants2017-07-01220
2016: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2016 401k membership
Total participants, beginning-of-year2016-07-01144
Total number of active participants reported on line 7a of the Form 55002016-07-01220
Total of all active and inactive participants2016-07-01220
Total participants, beginning-of-year2016-06-01144
Total number of active participants reported on line 7a of the Form 55002016-06-01144
Total of all active and inactive participants2016-06-01144
2015: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2015 401k membership
Total participants, beginning-of-year2015-06-01144
Total number of active participants reported on line 7a of the Form 55002015-06-01144
Total of all active and inactive participants2015-06-01144
2014: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2014 401k membership
Total participants, beginning-of-year2014-06-01158
Total number of active participants reported on line 7a of the Form 55002014-06-01144
Total of all active and inactive participants2014-06-01144
2013: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2013 401k membership
Total participants, beginning-of-year2013-06-01156
Total number of active participants reported on line 7a of the Form 55002013-06-01158
Total of all active and inactive participants2013-06-01158
2012: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2012 401k membership
Total participants, beginning-of-year2012-06-01107
Total number of active participants reported on line 7a of the Form 55002012-06-01156
Total of all active and inactive participants2012-06-01156
2011: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2011 401k membership
Total participants, beginning-of-year2011-06-01124
Total number of active participants reported on line 7a of the Form 55002011-06-01107
Total of all active and inactive participants2011-06-01107
2010: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2010 401k membership
Total participants, beginning-of-year2010-06-01126
2009: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2009 401k membership
Total participants, beginning-of-year2009-06-01106
2008: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2008 401k membership
Total participants, beginning-of-year2008-06-01109
2007: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2007 401k membership
Total participants, beginning-of-year2007-06-01115
2006: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2006 401k membership
Total participants, beginning-of-year2006-06-01107
2005: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2005 401k membership
Total participants, beginning-of-year2005-06-01108
2004: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2004 401k membership
Total participants, beginning-of-year2004-06-01108
2003: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2003 401k membership
Total participants, beginning-of-year2003-06-01118
2002: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2002 401k membership
Total participants, beginning-of-year2002-06-01116
2001: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2001 401k membership
Total participants, beginning-of-year2001-06-01116

Financial Data on SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE

Measure Date Value
2012 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2012 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-05-31No
Was this plan covered by a fidelity bond2012-05-31No
If this is an individual account plan, was there a blackout period2012-05-31No
Were there any nonexempt tranactions with any party-in-interest2012-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-05-31No
Were any leases to which the plan was party in default or uncollectible2012-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-05-31No
Was there a failure to transmit to the plan any participant contributions2012-05-31No
Has the plan failed to provide any benefit when due under the plan2012-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-05-31No
Did the plan have assets held for investment2012-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-05-31No
2011 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2011 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-05-31No
Was this plan covered by a fidelity bond2011-05-31No
If this is an individual account plan, was there a blackout period2011-05-31No
Were there any nonexempt tranactions with any party-in-interest2011-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-05-31No
Were any leases to which the plan was party in default or uncollectible2011-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-05-31No
Was there a failure to transmit to the plan any participant contributions2011-05-31No
Has the plan failed to provide any benefit when due under the plan2011-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-05-31No
Did the plan have assets held for investment2011-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-05-31No
2010 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2010 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-05-31No
Was this plan covered by a fidelity bond2010-05-31No
If this is an individual account plan, was there a blackout period2010-05-31No
Were there any nonexempt tranactions with any party-in-interest2010-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-05-31No
Were any leases to which the plan was party in default or uncollectible2010-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-05-31No
Was there a failure to transmit to the plan any participant contributions2010-05-31No
Has the plan failed to provide any benefit when due under the plan2010-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-05-31No
Did the plan have assets held for investment2010-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-05-31No
2009 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2009 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2009-05-31No
Was this plan covered by a fidelity bond2009-05-31No
If this is an individual account plan, was there a blackout period2009-05-31No
Were there any nonexempt tranactions with any party-in-interest2009-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2009-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2009-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2009-05-31No
Were any leases to which the plan was party in default or uncollectible2009-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2009-05-31No
Was there a failure to transmit to the plan any participant contributions2009-05-31No
Has the plan failed to provide any benefit when due under the plan2009-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32009-05-31No
Did the plan have assets held for investment2009-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2009-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2009-05-31No
2008 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2008 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2008-05-31No
Was this plan covered by a fidelity bond2008-05-31No
If this is an individual account plan, was there a blackout period2008-05-31No
Were there any nonexempt tranactions with any party-in-interest2008-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2008-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2008-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2008-05-31No
Were any leases to which the plan was party in default or uncollectible2008-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2008-05-31No
Was there a failure to transmit to the plan any participant contributions2008-05-31No
Has the plan failed to provide any benefit when due under the plan2008-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32008-05-31No
Did the plan have assets held for investment2008-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2008-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2008-05-31No
2007 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2007 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2007-05-31No
Was this plan covered by a fidelity bond2007-05-31No
If this is an individual account plan, was there a blackout period2007-05-31No
Were there any nonexempt tranactions with any party-in-interest2007-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2007-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2007-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2007-05-31No
Were any leases to which the plan was party in default or uncollectible2007-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2007-05-31No
Was there a failure to transmit to the plan any participant contributions2007-05-31No
Has the plan failed to provide any benefit when due under the plan2007-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32007-05-31No
Did the plan have assets held for investment2007-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2007-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2007-05-31No
2006 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2006 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2006-05-31No
Was this plan covered by a fidelity bond2006-05-31No
If this is an individual account plan, was there a blackout period2006-05-31No
Were there any nonexempt tranactions with any party-in-interest2006-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2006-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2006-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2006-05-31No
Were any leases to which the plan was party in default or uncollectible2006-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2006-05-31No
Was there a failure to transmit to the plan any participant contributions2006-05-31No
Has the plan failed to provide any benefit when due under the plan2006-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32006-05-31No
Did the plan have assets held for investment2006-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2006-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2006-05-31No
2005 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2005 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2005-05-31No
Was this plan covered by a fidelity bond2005-05-31No
If this is an individual account plan, was there a blackout period2005-05-31No
Were there any nonexempt tranactions with any party-in-interest2005-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2005-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2005-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2005-05-31No
Were any leases to which the plan was party in default or uncollectible2005-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2005-05-31No
Was there a failure to transmit to the plan any participant contributions2005-05-31No
Has the plan failed to provide any benefit when due under the plan2005-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32005-05-31No
Did the plan have assets held for investment2005-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2005-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2005-05-31No
2004 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2004 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2004-05-31No
Was this plan covered by a fidelity bond2004-05-31No
If this is an individual account plan, was there a blackout period2004-05-31No
Were there any nonexempt tranactions with any party-in-interest2004-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2004-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2004-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2004-05-31No
Were any leases to which the plan was party in default or uncollectible2004-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2004-05-31No
Was there a failure to transmit to the plan any participant contributions2004-05-31No
Has the plan failed to provide any benefit when due under the plan2004-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32004-05-31No
Did the plan have assets held for investment2004-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2004-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2004-05-31No
2003 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2003 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2003-05-31No
Was this plan covered by a fidelity bond2003-05-31No
If this is an individual account plan, was there a blackout period2003-05-31No
Were there any nonexempt tranactions with any party-in-interest2003-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2003-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2003-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2003-05-31No
Were any leases to which the plan was party in default or uncollectible2003-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2003-05-31No
Was there a failure to transmit to the plan any participant contributions2003-05-31No
Has the plan failed to provide any benefit when due under the plan2003-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32003-05-31No
Did the plan have assets held for investment2003-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2003-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2003-05-31No
2002 : SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2002 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2002-05-31No
Was this plan covered by a fidelity bond2002-05-31No
If this is an individual account plan, was there a blackout period2002-05-31No
Were there any nonexempt tranactions with any party-in-interest2002-05-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2002-05-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2002-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2002-05-31No
Were any leases to which the plan was party in default or uncollectible2002-05-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2002-05-31No
Was there a failure to transmit to the plan any participant contributions2002-05-31No
Has the plan failed to provide any benefit when due under the plan2002-05-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32002-05-31No
Did the plan have assets held for investment2002-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2002-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2002-05-31No

Form 5500 Responses for SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE

2021: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-06-01Type of plan entitySingle employer plan
2016-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedYes
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedYes
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedYes
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes
2008: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2008 form 5500 responses
2008-06-01Type of plan entitySingle employer plan
2008-06-01Plan funding arrangement – InsuranceYes
2008-06-01Plan benefit arrangement – InsuranceYes
2007: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2007 form 5500 responses
2007-06-01Type of plan entitySingle employer plan
2007-06-01Plan funding arrangement – InsuranceYes
2007-06-01Plan benefit arrangement – InsuranceYes
2006: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2006 form 5500 responses
2006-06-01Type of plan entitySingle employer plan
2006-06-01Plan funding arrangement – InsuranceYes
2006-06-01Plan benefit arrangement – InsuranceYes
2005: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2005 form 5500 responses
2005-06-01Type of plan entitySingle employer plan
2005-06-01Plan funding arrangement – InsuranceYes
2005-06-01Plan benefit arrangement – InsuranceYes
2004: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2004 form 5500 responses
2004-06-01Type of plan entitySingle employer plan
2004-06-01Plan funding arrangement – InsuranceYes
2004-06-01Plan benefit arrangement – InsuranceYes
2003: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2003 form 5500 responses
2003-06-01Type of plan entitySingle employer plan
2003-06-01Plan funding arrangement – InsuranceYes
2003-06-01Plan benefit arrangement – InsuranceYes
2002: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2002 form 5500 responses
2002-06-01Type of plan entitySingle employer plan
2002-06-01Plan funding arrangement – InsuranceYes
2002-06-01Plan benefit arrangement – InsuranceYes
2001: SISTERS OF ST. ANNE, INC. D/B/A ANNA MARIA COLLEGE 2001 form 5500 responses
2001-06-01Type of plan entitySingle employer plan
2001-06-01Plan funding arrangement – InsuranceYes
2001-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 158782
Policy instance 5
Insurance contract or identification numberGL 158782
Number of Individuals Covered144
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,081
Total amount of fees paid to insurance companyUSD $693
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,081
Amount paid for insurance broker fees378
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 2
Insurance contract or identification numberGTU3586763
Number of Individuals Covered122
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_2
Policy instance 4
Insurance contract or identification number6792_2
Number of Individuals Covered41
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $973
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $973
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30025733
Policy instance 1
Insurance contract or identification number30025733
Number of Individuals Covered53
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $770
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $770
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 129573
Policy instance 6
Insurance contract or identification numberLTD 129573
Number of Individuals Covered144
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,422
Total amount of fees paid to insurance companyUSD $603
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,422
Amount paid for insurance broker fees329
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 207901
Policy instance 7
Insurance contract or identification numberVAR 207901
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&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 numberVG 186956
Policy instance 8
Insurance contract or identification numberVG 186956
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY 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 Covered135
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedOTHER
Welfare Benefit Premiums Paid to CarrierUSD $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 number6792_1
Policy instance 3
Insurance contract or identification number6792_1
Number of Individuals Covered80
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $3,032
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,032
Insurance broker organization code?3
NEIGHBORHOOD HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 11109 )
Policy contract numberARAC100926008/9
Policy instance 11
Insurance contract or identification numberARAC100926008/9
Number of Individuals Covered88
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $36,500
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $36,500
HR CONCEPTS, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 9
Number of Individuals Covered28
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,872
Other welfare benefits providedFSA BENEFITS AND COBRA ADMIN
Welfare Benefit Premiums Paid to CarrierUSD $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 fees1872
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 129573
Policy instance 8
Insurance contract or identification numberLTD 129573
Number of Individuals Covered132
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,945
Total amount of fees paid to insurance companyUSD $684
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,945
Amount paid for insurance broker fees439
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30025733
Policy instance 1
Insurance contract or identification number30025733
Number of Individuals Covered41
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $640
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $640
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 2
Insurance contract or identification numberGTU3586763
Number of Individuals Covered122
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
Policy contract numberC002230025C01
Policy instance 4
Insurance contract or identification numberC002230025C01
Number of Individuals Covered12
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $1,472
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $71,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,472
Insurance broker organization code?3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_1
Policy instance 5
Insurance contract or identification number6792_1
Number of Individuals Covered86
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,906
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,906
Insurance broker organization code?3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_2
Policy instance 6
Insurance contract or identification number6792_2
Number of Individuals Covered34
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $834
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 Covered135
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedOTHER
Welfare Benefit Premiums Paid to CarrierUSD $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 Covered25
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,350
Other welfare benefits providedFSA BENEFITS AND COBRA ADMIN
Welfare Benefit Premiums Paid to CarrierUSD $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 fees1350
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 158782
Policy instance 7
Insurance contract or identification numberGL 158782
Number of Individuals Covered140
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,011
Total amount of fees paid to insurance companyUSD $747
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,011
Amount paid for insurance broker fees480
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 207901
Policy instance 9
Insurance contract or identification numberVAR 207901
Number of Individuals Covered12
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $52
Total amount of fees paid to insurance companyUSD $13
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52
Amount paid for insurance broker fees8
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 186956
Policy instance 10
Insurance contract or identification numberVG 186956
Number of Individuals Covered12
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $457
Total amount of fees paid to insurance companyUSD $141
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $4,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $457
Amount paid for insurance broker fees91
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract numberC002230025C01
Policy instance 3
Insurance contract or identification numberC002230025C01
Number of Individuals Covered148
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $23,766
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $23,766
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVG 186956
Policy instance 10
Insurance contract or identification numberVG 186956
Number of Individuals Covered11
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $403
Total amount of fees paid to insurance companyUSD $284
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $4,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $403
Amount paid for insurance broker fees155
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 207901
Policy instance 9
Insurance contract or identification numberVAR 207901
Number of Individuals Covered16
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $54
Total amount of fees paid to insurance companyUSD $33
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54
Amount paid for insurance broker fees18
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 129573
Policy instance 8
Insurance contract or identification numberLTD 129573
Number of Individuals Covered128
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,610
Total amount of fees paid to insurance companyUSD $1,117
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,610
Amount paid for insurance broker fees609
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 158782
Policy instance 7
Insurance contract or identification numberGL 158782
Number of Individuals Covered133
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,698
Total amount of fees paid to insurance companyUSD $1,247
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,698
Amount paid for insurance broker fees680
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_2
Policy instance 6
Insurance contract or identification number6792_2
Number of Individuals Covered32
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $890
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $890
Insurance broker organization code?3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_1
Policy instance 5
Insurance contract or identification number6792_1
Number of Individuals Covered75
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,712
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 numberC002230025C01
Policy instance 4
Insurance contract or identification numberC002230025C01
Number of Individuals Covered11
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,619
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $106,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,619
Insurance broker organization code?3
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract numberC002230025C01
Policy instance 3
Insurance contract or identification numberC002230025C01
Number of Individuals Covered130
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $29,498
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $29,498
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 2
Insurance contract or identification numberGTU3586763
Number of Individuals Covered122
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $405
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $405
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30025733
Policy instance 1
Insurance contract or identification number30025733
Number of Individuals Covered34
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $598
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 Covered135
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedOTHER
Welfare Benefit Premiums Paid to CarrierUSD $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 Covered19
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,277
Other welfare benefits providedFSA BENEFITS AND COBRA ADMIN
Welfare Benefit Premiums Paid to CarrierUSD $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 fees1277
HR CONCEPTS, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 13
Number of Individuals Covered25
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,470
Other welfare benefits providedFSA BENEFITS AND COBRA ADMIN
Welfare Benefit Premiums Paid to CarrierUSD $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 fees1470
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
E4 LLC (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number
Policy instance 11
Number of Individuals Covered220
Insurance policy start date2018-06-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberVG 186956
Policy instance 10
Insurance contract or identification numberVG 186956
Number of Individuals Covered15
Insurance policy start date2018-11-01
Insurance policy end date2019-10-21
Total amount of commissions paid to insurance brokerUSD $565
Total amount of fees paid to insurance companyUSD $275
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
Welfare Benefit Premiums Paid to CarrierUSD $5,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $565
Amount paid for insurance broker fees275
Additional information about fees paid to insurance brokerTOTAL 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 numberLTD 129573
Policy instance 8
Insurance contract or identification numberLTD 129573
Number of Individuals Covered119
Insurance policy start date2018-11-01
Insurance policy end date2019-10-21
Total amount of commissions paid to insurance brokerUSD $2,803
Total amount of fees paid to insurance companyUSD $757
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,803
Amount paid for insurance broker fees757
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 207901
Policy instance 9
Insurance contract or identification numberVAR 207901
Number of Individuals Covered22
Insurance policy start date2018-11-01
Insurance policy end date2019-10-21
Total amount of commissions paid to insurance brokerUSD $98
Total amount of fees paid to insurance companyUSD $33
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98
Amount paid for insurance broker fees33
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 2
Insurance contract or identification numberGTU3586763
Number of Individuals Covered0
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 158782
Policy instance 7
Insurance contract or identification numberGL 158782
Number of Individuals Covered127
Insurance policy start date2018-11-01
Insurance policy end date2019-10-21
Total amount of commissions paid to insurance brokerUSD $1,914
Total amount of fees paid to insurance companyUSD $845
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,914
Amount paid for insurance broker fees845
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_2
Policy instance 6
Insurance contract or identification number6792_2
Number of Individuals Covered38
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $955
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $955
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_1
Policy instance 5
Insurance contract or identification number6792_1
Number of Individuals Covered69
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $2,742
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,742
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
Policy contract numberC002230025C01
Policy instance 4
Insurance contract or identification numberC002230025C01
Number of Individuals Covered14
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $2,216
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $85,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,216
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30025733
Policy instance 1
Insurance contract or identification number30025733
Number of Individuals Covered34
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $610
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $610
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract numberC002230025C01
Policy instance 3
Insurance contract or identification numberC002230025C01
Number of Individuals Covered118
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $22,172
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $886,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $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 Covered200
Insurance policy start date2019-01-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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 number30025733
Policy instance 1
Insurance contract or identification number30025733
Number of Individuals Covered32
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $582
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 Covered220
Insurance policy start date2018-01-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberC002230025C01
Policy instance 3
Insurance contract or identification numberC002230025C01
Number of Individuals Covered111
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $24,702
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $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 numberC002230025C01
Policy instance 4
Insurance contract or identification numberC002230025C01
Number of Individuals Covered14
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $3,476
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $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 number6792_1
Policy instance 5
Insurance contract or identification number6792_1
Number of Individuals Covered66
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,766
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number6792_2
Policy instance 6
Insurance contract or identification number6792_2
Number of Individuals Covered29
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $828
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberGL 158782
Policy instance 8
Insurance contract or identification numberGL 158782
Number of Individuals Covered121
Insurance policy start date2017-11-01
Insurance policy end date2018-11-01
Total amount of commissions paid to insurance brokerUSD $1,554
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 Covered220
Insurance policy start date2017-06-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberVAR 207901
Policy instance 11
Insurance contract or identification numberVAR 207901
Number of Individuals Covered27
Insurance policy start date2017-11-01
Insurance policy end date2018-11-01
Total amount of commissions paid to insurance brokerUSD $106
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 numberVG 186956
Policy instance 7
Insurance contract or identification numberVG 186956
Number of Individuals Covered18
Insurance policy start date2017-11-01
Insurance policy end date2018-11-01
Total amount of commissions paid to insurance brokerUSD $588
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberGTU3586763
Policy instance 2
Insurance contract or identification numberGTU3586763
Number of Individuals Covered113
Insurance policy start date2017-06-01
Insurance policy end date2018-06-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&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 numberLTD 129573
Policy instance 9
Insurance contract or identification numberLTD 129573
Number of Individuals Covered113
Insurance policy start date2017-11-01
Insurance policy end date2018-11-01
Total amount of commissions paid to insurance brokerUSD $2,250
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number0841670000
Policy instance 2
Insurance contract or identification number0841670000
Number of Individuals Covered33
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $4,843
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $192,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,836
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841680000
Policy instance 3
Insurance contract or identification number0841680000
Number of Individuals Covered52
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $8,755
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $345,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,743
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841690000
Policy instance 4
Insurance contract or identification number0841690000
Number of Individuals Covered44
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $5,915
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $233,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,907
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_1
Policy instance 5
Insurance contract or identification number6792_1
Number of Individuals Covered52
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $1,562
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,562
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_2
Policy instance 6
Insurance contract or identification number6792_2
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $600
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $600
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100018943
Policy instance 7
Insurance contract or identification number40000100018943
Number of Individuals Covered33
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $917
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $917
Additional information about fees paid to insurance brokerTHE
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INS BRKRGE LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00101972870000
Policy instance 8
Insurance contract or identification number00101972870000
Number of Individuals Covered129
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $1,826
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $18,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,826
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INS BRKRGE LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30025733
Policy instance 9
Insurance contract or identification number30025733
Number of Individuals Covered32
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $576
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $576
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00101972880000
Policy instance 10
Insurance contract or identification number00101972880000
Number of Individuals Covered113
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $2,582
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,582
Insurance broker organization code?3
Insurance broker nameAISLING 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 Covered220
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 number0841700000
Policy instance 12
Insurance contract or identification number0841700000
Number of Individuals Covered7
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $747
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $29,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $746
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 1
Insurance contract or identification numberGTU3586763
Number of Individuals Covered113
Insurance policy start date2016-06-01
Insurance policy end date2017-06-01
Total amount of commissions paid to insurance brokerUSD $405
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $405
Insurance broker organization code?3
Insurance broker nameFRED C. CHURCH
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841680000
Policy instance 4
Insurance contract or identification number0841680000
Number of Individuals Covered52
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $8,755
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $345,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,743
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00101972870000
Policy instance 11
Insurance contract or identification number00101972870000
Number of Individuals Covered129
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $1,826
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $18,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,826
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INS BRKRGE LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30025733
Policy instance 1
Insurance contract or identification number30025733
Number of Individuals Covered32
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $576
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $576
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 2
Insurance contract or identification numberGTU3586763
Number of Individuals Covered137
Insurance policy start date2013-06-01
Insurance policy end date2016-06-01
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedTRAVEL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameFRED C. CHURCH
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841670000
Policy instance 3
Insurance contract or identification number0841670000
Number of Individuals Covered33
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $4,843
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $192,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,836
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100018943
Policy instance 10
Insurance contract or identification number40000100018943
Number of Individuals Covered33
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $917
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY AD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $917
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INS BRKRGE LLC
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_2
Policy instance 8
Insurance contract or identification number6792_2
Number of Individuals Covered34
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $600
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $600
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841690000
Policy instance 5
Insurance contract or identification number0841690000
Number of Individuals Covered44
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $5,915
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $233,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,907
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841700000
Policy instance 6
Insurance contract or identification number0841700000
Number of Individuals Covered7
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $747
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $29,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $746
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_1
Policy instance 7
Insurance contract or identification number6792_1
Number of Individuals Covered52
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $1,562
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,562
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
E4 WELLNESS, INC (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number
Policy instance 9
Number of Individuals Covered220
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEAP/WELLNESS
Welfare Benefit Premiums Paid to CarrierUSD $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 number001019728800000
Policy instance 12
Insurance contract or identification number001019728800000
Number of Individuals Covered113
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $2,582
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,582
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INS BRKRGE LLC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841670000
Policy instance 4
Insurance contract or identification number0841670000
Number of Individuals Covered38
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $6,329
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $244,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,332
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841680000
Policy instance 5
Insurance contract or identification number0841680000
Number of Individuals Covered58
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $8,375
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $326,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,409
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841690000
Policy instance 6
Insurance contract or identification number0841690000
Number of Individuals Covered43
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $5,696
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $221,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,999
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841700000
Policy instance 7
Insurance contract or identification number0841700000
Number of Individuals Covered5
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $604
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $23,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $318
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_1
Policy instance 8
Insurance contract or identification number6792_1
Number of Individuals Covered50
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,212
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,212
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered101
Insurance policy end date2015-06-01
Total amount of commissions paid to insurance brokerUSD $1,952
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE, VOL DEP LIFE, VOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $16,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,952
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INSURANCE
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number6792_2
Policy instance 9
Insurance contract or identification number6792_2
Number of Individuals Covered39
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $955
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $955
Insurance broker organization code?3
Insurance broker nameRSC INSURANCE BROKERAGE, INC.
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number1911
Policy instance 10
Insurance contract or identification number1911
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $100
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $100
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER POWERS
E4 WELLNESS, INC (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number
Policy instance 11
Number of Individuals Covered220
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEAP/WELLNESS
Welfare Benefit Premiums Paid to CarrierUSD $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 numberGTU3586763
Policy instance 3
Insurance contract or identification numberGTU3586763
Number of Individuals Covered137
Insurance policy start date2013-06-01
Insurance policy end date2016-06-01
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedTRAVEL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameFRED C. CHURCH
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30025733
Policy instance 2
Insurance contract or identification number30025733
Number of Individuals Covered33
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $524
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $355
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER POWERS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30025733
Policy instance 3
Insurance contract or identification number30025733
Number of Individuals Covered24
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $391
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $254
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER POWERS
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 4
Insurance contract or identification numberGTU3586763
Number of Individuals Covered137
Insurance policy start date2013-06-01
Insurance policy end date2016-06-01
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameFRED C. CHURCH
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841690000
Policy instance 7
Insurance contract or identification number0841690000
Number of Individuals Covered37
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $7,768
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $193,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,768
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841700000
Policy instance 8
Insurance contract or identification number0841700000
Number of Individuals Covered11
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,749
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $43,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,749
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00369124
Policy instance 2
Insurance contract or identification number00369124
Number of Individuals Covered50
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,756
Total amount of fees paid to insurance companyUSD $1,995
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,406
Insurance broker organization code?3
Amount paid for insurance broker fees1995
Additional information about fees paid to insurance brokerMISCELLANEOUS FEES
Insurance broker nameBULFINCH GROUP INSURANCE AGENCY, LL
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered111
Insurance policy end date2014-06-01
Total amount of commissions paid to insurance brokerUSD $4,956
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE, VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $42,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,956
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INSURANCE
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841670000
Policy instance 5
Insurance contract or identification number0841670000
Number of Individuals Covered51
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $11,631
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $290,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,631
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0841680000
Policy instance 6
Insurance contract or identification number0841680000
Number of Individuals Covered59
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $15,008
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $374,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,008
Insurance broker organization code?3
Insurance broker nameMICHAEL TSOTSIS
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
Policy contract numberC002230025C01
Policy instance 4
Insurance contract or identification numberC002230025C01
Number of Individuals Covered13
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,289
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $82,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,488
Insurance broker nameCHRISTOPHER POWERS
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract numberC002230025C01
Policy instance 3
Insurance contract or identification numberC002230025C01
Number of Individuals Covered156
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $23,861
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $866,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,509
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER POWERS
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00369124
Policy instance 2
Insurance contract or identification number00369124
Number of Individuals Covered54
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,821
Total amount of fees paid to insurance companyUSD $2,317
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,766
Insurance broker organization code?3
Amount paid for insurance broker fees2317
Additional information about fees paid to insurance brokerMISCELLANEOUS FEES
Insurance broker nameROBERT FINE
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 6
Insurance contract or identification numberGTU3586763
Number of Individuals Covered137
Insurance policy start date2010-06-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedTRAVEL AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker nameFRED C. CHURCH
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered111
Insurance policy start date2012-06-01
Insurance policy end date2013-06-01
Total amount of commissions paid to insurance brokerUSD $4,716
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedBASIC AD&D,VOL LIFE/DEP LIFE/AD&D
Welfare Benefit Premiums Paid to CarrierUSD $38,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,716
Insurance broker organization code?3
Insurance broker nameAISLING PARTNERS INSURANCE
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30025733
Policy instance 5
Insurance contract or identification number30025733
Number of Individuals Covered25
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $396
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $257
Insurance broker nameCHRISTOPHER POWERS
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract numberGTU3586763
Policy instance 6
Insurance contract or identification numberGTU3586763
Number of Individuals Covered137
Insurance policy start date2010-06-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number00369124
Policy instance 2
Insurance contract or identification number00369124
Number of Individuals Covered55
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $2,786
Total amount of fees paid to insurance companyUSD $3,566
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered107
Insurance policy end date2012-06-01
Total amount of commissions paid to insurance brokerUSD $3,947
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE, VOL DEP LIFE, VOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 number4450424
Policy instance 3
Insurance contract or identification number4450424
Number of Individuals Covered151
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $21,213
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 number9982520
Policy instance 4
Insurance contract or identification number9982520
Number of Individuals Covered4
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $1,688
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 number30025733
Policy instance 5
Insurance contract or identification number30025733
Number of Individuals Covered15
Insurance policy start date2011-07-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $183
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered124
Insurance policy end date2011-06-01
Total amount of commissions paid to insurance brokerUSD $4,377
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE, VOL DEP LIFE, VOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 number00369124
Policy instance 2
Insurance contract or identification number00369124
Number of Individuals Covered51
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $2,644
Total amount of fees paid to insurance companyUSD $2,907
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number4450424
Policy instance 3
Insurance contract or identification number4450424
Number of Individuals Covered175
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $36,813
Total amount of fees paid to insurance companyUSD $99,295
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 numberGTU 3586763
Policy instance 5
Insurance contract or identification numberGTU 3586763
Number of Individuals Covered137
Insurance policy start date2010-06-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number9982520
Policy instance 4
Insurance contract or identification number9982520
Number of Individuals Covered8
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $705
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 number4450424
Policy instance 3
Insurance contract or identification number4450424
Number of Individuals Covered164
Insurance policy start date2009-06-01
Insurance policy end date2010-05-31
Total amount of commissions paid to insurance brokerUSD $27,050
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 number00369124
Policy instance 2
Insurance contract or identification number00369124
Number of Individuals Covered51
Insurance policy start date2009-06-01
Insurance policy end date2010-05-31
Total amount of commissions paid to insurance brokerUSD $2,549
Total amount of fees paid to insurance companyUSD $2,642
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered126
Insurance policy end date2010-06-01
Total amount of commissions paid to insurance brokerUSD $3,941
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE, VOL DEP LIFE,VOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $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 number9982520
Policy instance 4
Insurance contract or identification number9982520
Number of Individuals Covered5
Insurance policy start date2009-06-01
Insurance policy end date2010-05-31
Total amount of commissions paid to insurance brokerUSD $1,406
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $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 number4450424
Policy instance 3
Insurance contract or identification number4450424
Number of Individuals Covered82
Insurance policy start date2008-06-01
Insurance policy end date2009-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number00369124
Policy instance 2
Insurance contract or identification number00369124
Number of Individuals Covered47
Insurance policy start date2008-06-01
Insurance policy end date2009-05-31
Total amount of commissions paid to insurance brokerUSD $2,441
Total amount of fees paid to insurance companyUSD $2,435
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered106
Insurance policy end date2009-06-01
Total amount of commissions paid to insurance brokerUSD $2,715
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 Covered2
Insurance policy start date2007-06-01
Insurance policy end date2008-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number454-5328-00
Policy instance 1
Insurance contract or identification number454-5328-00
Number of Individuals Covered109
Insurance policy end date2008-05-31
Total amount of commissions paid to insurance brokerUSD $3,322
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL LIFE, VOL DEP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $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 number4450424
Policy instance 3
Insurance contract or identification number4450424
Number of Individuals Covered66
Insurance policy start date2007-06-01
Insurance policy end date2008-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number00369124
Policy instance 2
Insurance contract or identification number00369124
Number of Individuals Covered42
Insurance policy start date2007-06-01
Insurance policy end date2008-05-31
Total amount of commissions paid to insurance brokerUSD $2,483
Total amount of fees paid to insurance companyUSD $2,754
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number00369124
Policy instance 3
Insurance contract or identification number00369124
Number of Individuals Covered49
Insurance policy start date2006-06-01
Insurance policy end date2007-05-31
Total amount of commissions paid to insurance brokerUSD $2,440
Total amount of fees paid to insurance companyUSD $2,436
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number139026
Policy instance 2
Insurance contract or identification number139026
Number of Individuals Covered110
Insurance policy start date2006-06-01
Insurance policy end date2007-05-31
Total amount of commissions paid to insurance brokerUSD $1,649
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
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 number139026
Policy instance 1
Insurance contract or identification number139026
Number of Individuals Covered115
Insurance policy start date2006-06-01
Insurance policy end date2007-05-31
Total amount of commissions paid to insurance brokerUSD $1,282
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
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 Covered2
Insurance policy start date2006-06-01
Insurance policy end date2007-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number4450424
Policy instance 4
Insurance contract or identification number4450424
Number of Individuals Covered78
Insurance policy start date2006-06-01
Insurance policy end date2007-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number139026
Policy instance 1
Insurance contract or identification number139026
Number of Individuals Covered107
Insurance policy start date2005-06-01
Insurance policy end date2006-05-31
Total amount of commissions paid to insurance brokerUSD $1,236
Total amount of fees paid to insurance companyUSD $218
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
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 Covered3
Insurance policy start date2005-06-01
Insurance policy end date2006-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number4450424
Policy instance 4
Insurance contract or identification number4450424
Number of Individuals Covered80
Insurance policy start date2005-06-01
Insurance policy end date2006-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number00369124
Policy instance 3
Insurance contract or identification number00369124
Number of Individuals Covered46
Insurance policy start date2005-06-01
Insurance policy end date2006-05-31
Total amount of commissions paid to insurance brokerUSD $2,430
Total amount of fees paid to insurance companyUSD $1,662
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,864
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 number139026
Policy instance 2
Insurance contract or identification number139026
Number of Individuals Covered104
Insurance policy start date2005-06-01
Insurance policy end date2006-05-31
Total amount of commissions paid to insurance brokerUSD $1,574
Total amount of fees paid to insurance companyUSD $193
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
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 number00369124
Policy instance 4
Insurance contract or identification number00369124
Number of Individuals Covered44
Insurance policy start date2004-06-01
Insurance policy end date2005-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
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 Covered4
Insurance policy start date2004-06-01
Insurance policy end date2005-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number44054
Policy instance 3
Insurance contract or identification number44054
Number of Individuals Covered73
Insurance policy start date2004-06-01
Insurance policy end date2005-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 numberVAR 201621
Policy instance 2
Insurance contract or identification numberVAR 201621
Number of Individuals Covered55
Insurance policy end date2005-05-31
Total amount of commissions paid to insurance brokerUSD $64
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $639
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 numberGL 131652
Policy instance 1
Insurance contract or identification numberGL 131652
Number of Individuals Covered55
Insurance policy end date2005-05-31
Total amount of commissions paid to insurance brokerUSD $939
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,513
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 Covered9
Insurance policy start date2003-06-01
Insurance policy end date2004-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number00369124
Policy instance 4
Insurance contract or identification number00369124
Number of Individuals Covered47
Insurance policy start date2003-06-01
Insurance policy end date2004-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
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 number4450424
Policy instance 3
Insurance contract or identification number4450424
Number of Individuals Covered66
Insurance policy start date2003-06-01
Insurance policy end date2004-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 numberVAR 201621
Policy instance 2
Insurance contract or identification numberVAR 201621
Number of Individuals Covered50
Insurance policy start date2003-06-01
Insurance policy end date2004-05-31
Total amount of commissions paid to insurance brokerUSD $67
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedACCIDENTAL DEATH AND DISBURSEMENT
Welfare Benefit Premiums Paid to CarrierUSD $675
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 numberGL 131652
Policy instance 1
Insurance contract or identification numberGL 131652
Number of Individuals Covered50
Insurance policy start date2003-06-01
Insurance policy end date2004-05-31
Total amount of commissions paid to insurance brokerUSD $1,022
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 numberGL 131652
Policy instance 1
Insurance contract or identification numberGL 131652
Number of Individuals Covered53
Insurance policy end date2003-05-31
Total amount of commissions paid to insurance brokerUSD $1,108
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $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 number4450424
Policy instance 3
Insurance contract or identification number4450424
Number of Individuals Covered64
Insurance policy start date2002-06-01
Insurance policy end date2003-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number00369124
Policy instance 4
Insurance contract or identification number00369124
Number of Individuals Covered46
Insurance policy start date2002-06-01
Insurance policy end date2003-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
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 Covered10
Insurance policy start date2002-06-01
Insurance policy end date2003-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 numberVAR 201621
Policy instance 2
Insurance contract or identification numberVAR 201621
Number of Individuals Covered53
Insurance policy end date2003-05-31
Total amount of commissions paid to insurance brokerUSD $76
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTHCARE OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 5
Number of Individuals Covered51
Insurance policy start date2001-06-01
Insurance policy end date2002-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
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 number4450424
Policy instance 4
Insurance contract or identification number4450424
Number of Individuals Covered44
Insurance policy start date2001-06-01
Insurance policy end date2002-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number
Policy instance 3
Number of Individuals Covered15
Insurance policy start date2001-06-01
Insurance policy end date2002-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
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 numberVAR 201621
Policy instance 2
Insurance contract or identification numberVAR 201621
Number of Individuals Covered51
Insurance policy end date2002-05-31
Total amount of commissions paid to insurance brokerUSD $6
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $56
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 numberGL131652
Policy instance 1
Insurance contract or identification numberGL131652
Number of Individuals Covered51
Insurance policy end date2002-05-31
Total amount of commissions paid to insurance brokerUSD $110
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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