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COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 401k Plan overview

Plan NameCOX ENGINEERING COMPANY WELFARE BENEFIT PLAN
Plan identification number 501

COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 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
  • 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

COX ENGINEERING COMPANY has sponsored the creation of one or more 401k plans.

Company Name:COX ENGINEERING COMPANY
Employer identification number (EIN):042017923
NAIC Classification:333410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COX ENGINEERING COMPANY WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-06-01
5012021-06-01
5012020-06-01
5012019-06-01
5012018-06-01
5012017-06-01ATHENA STAMM
5012016-06-01ALISON CONROY
5012015-06-01MICHAEL DONOVAN
5012010-06-01MICHAEL DONOVAN
5012009-06-01MICHAEL DONOVAN

Plan Statistics for COX ENGINEERING COMPANY WELFARE BENEFIT PLAN

401k plan membership statisitcs for COX ENGINEERING COMPANY WELFARE BENEFIT PLAN

Measure Date Value
2022: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01289
Total number of active participants reported on line 7a of the Form 55002022-06-01262
Total of all active and inactive participants2022-06-01262
2021: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01228
Total number of active participants reported on line 7a of the Form 55002021-06-01262
Number of retired or separated participants receiving benefits2021-06-011
Total of all active and inactive participants2021-06-01263
2020: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01219
Total number of active participants reported on line 7a of the Form 55002020-06-01228
Number of retired or separated participants receiving benefits2020-06-011
Total of all active and inactive participants2020-06-01229
2019: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01183
Total number of active participants reported on line 7a of the Form 55002019-06-01219
Total of all active and inactive participants2019-06-01219
2018: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01150
Total number of active participants reported on line 7a of the Form 55002018-06-01183
Total of all active and inactive participants2018-06-01183
2017: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01108
Total number of active participants reported on line 7a of the Form 55002017-06-01149
Number of retired or separated participants receiving benefits2017-06-011
Total of all active and inactive participants2017-06-01150
Total participants2017-06-01150
2016: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01108
Total number of active participants reported on line 7a of the Form 55002016-06-01108
Number of retired or separated participants receiving benefits2016-06-010
Total of all active and inactive participants2016-06-01108
Total participants2016-06-01108
2015: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01105
Total number of active participants reported on line 7a of the Form 55002015-06-01110
Number of retired or separated participants receiving benefits2015-06-011
Number of other retired or separated participants entitled to future benefits2015-06-011
Total of all active and inactive participants2015-06-01112
Total participants2015-06-01112
2010: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01110
Total number of active participants reported on line 7a of the Form 55002010-06-01108
Number of retired or separated participants receiving benefits2010-06-013
Number of other retired or separated participants entitled to future benefits2010-06-012
Total of all active and inactive participants2010-06-01113
Total participants2010-06-01113
2009: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01127
Total number of active participants reported on line 7a of the Form 55002009-06-01105
Number of retired or separated participants receiving benefits2009-06-015
Number of other retired or separated participants entitled to future benefits2009-06-010
Total of all active and inactive participants2009-06-01110
Total participants2009-06-01110

Form 5500 Responses for COX ENGINEERING COMPANY WELFARE BENEFIT PLAN

2022: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan funding arrangement – General assets of the sponsorYes
2022-06-01Plan benefit arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – General assets of the sponsorYes
2021: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – General assets of the sponsorYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – General assets of the sponsorYes
2020: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – General assets of the sponsorYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – General assets of the sponsorYes
2019: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – General assets of the sponsorYes
2018: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – General assets of the sponsorYes
2016: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – General assets of the sponsorYes
2015: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – General assets of the sponsorYes
2010: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: COX ENGINEERING COMPANY WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number160408155902
Policy instance 1
Insurance contract or identification number160408155902
Number of Individuals Covered276
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $33,839
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,855,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,839
Insurance broker organization code?3
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number160408155902
Policy instance 2
Insurance contract or identification number160408155902
Number of Individuals Covered28
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $2,987
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $137,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,987
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number0152040000
Policy instance 3
Insurance contract or identification number0152040000
Number of Individuals Covered305
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $4,827
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,827
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30067873
Policy instance 4
Insurance contract or identification number30067873
Number of Individuals Covered108
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $853
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $853
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number712684
Policy instance 5
Insurance contract or identification number712684
Number of Individuals Covered289
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $11,526
Total amount of fees paid to insurance companyUSD $2,961
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $189,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,526
Amount paid for insurance broker fees2961
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number712685
Policy instance 6
Insurance contract or identification number712685
Number of Individuals Covered43
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $4,481
Total amount of fees paid to insurance companyUSD $485
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,481
Amount paid for insurance broker fees485
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number712686
Policy instance 7
Insurance contract or identification number712686
Number of Individuals Covered285
Insurance policy start date2022-06-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $7,026
Total amount of fees paid to insurance companyUSD $4,018
Other welfare benefits providedMA PFML
Welfare Benefit Premiums Paid to CarrierUSD $229,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,026
Amount paid for insurance broker fees4018
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number160408155902
Policy instance 1
Insurance contract or identification number160408155902
Number of Individuals Covered256
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $25,656
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,683,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,656
Insurance broker organization code?3
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number160408155902
Policy instance 2
Insurance contract or identification number160408155902
Number of Individuals Covered18
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,871
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,871
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number0152040000
Policy instance 3
Insurance contract or identification number0152040000
Number of Individuals Covered282
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $4,468
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,468
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30067873
Policy instance 4
Insurance contract or identification number30067873
Number of Individuals Covered88
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,613
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,613
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number878558G
Policy instance 5
Insurance contract or identification number878558G
Number of Individuals Covered249
Insurance policy start date2021-06-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $11,265
Total amount of fees paid to insurance companyUSD $7,555
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,265
Insurance broker organization code?3
Amount paid for insurance broker fees7555
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number712684
Policy instance 6
Insurance contract or identification number712684
Number of Individuals Covered262
Insurance policy start date2022-02-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $7,802
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,802
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number712685
Policy instance 7
Insurance contract or identification number712685
Number of Individuals Covered42
Insurance policy start date2022-02-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $1,740
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,740
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number712686
Policy instance 8
Insurance contract or identification number712686
Number of Individuals Covered84
Insurance policy start date2022-02-01
Insurance policy end date2022-05-31
Total amount of commissions paid to insurance brokerUSD $906
Other welfare benefits providedMA PFML
Welfare Benefit Premiums Paid to CarrierUSD $5,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $906
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number878558G
Policy instance 1
Insurance contract or identification number878558G
Number of Individuals Covered228
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $26,599
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $156,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,543
Insurance broker organization code?3
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number160408155902
Policy instance 3
Insurance contract or identification number160408155902
Number of Individuals Covered12
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $2,175
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,175
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30067873
Policy instance 4
Insurance contract or identification number30067873
Number of Individuals Covered69
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $733
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $733
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number160408155902
Policy instance 2
Insurance contract or identification number160408155902
Number of Individuals Covered244
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
Total amount of commissions paid to insurance brokerUSD $46,369
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,662,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,369
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4936867
Policy instance 2
Insurance contract or identification number4936867
Number of Individuals Covered121
Total amount of commissions paid to insurance brokerUSD $41,829
Health Insurance Welfare BenefitYes
Dental 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 $41,829
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number878558G
Policy instance 1
Insurance contract or identification number878558G
Number of Individuals Covered219
Total amount of commissions paid to insurance brokerUSD $15,158
Total amount of fees paid to insurance companyUSD $10,027
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $143,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,158
Insurance broker organization code?3
Amount paid for insurance broker fees10027
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30067873
Policy instance 3
Insurance contract or identification number30067873
Number of Individuals Covered62
Total amount of commissions paid to insurance brokerUSD $644
Vision 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 $644
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30067873
Policy instance 3
Insurance contract or identification number30067873
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $589
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,282
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $589
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number878558G
Policy instance 2
Insurance contract or identification number878558G
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $16,592
Total amount of fees paid to insurance companyUSD $11,288
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $158,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,592
Insurance broker organization code?3
Amount paid for insurance broker fees11288
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4936867
Policy instance 1
Insurance contract or identification number4936867
Number of Individuals Covered114
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $37,284
Health Insurance Welfare BenefitYes
Dental 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 $37,284
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number878558G
Policy instance 1
Insurance contract or identification number878558G
Total amount of commissions paid to insurance brokerUSD $10,643
Total amount of fees paid to insurance companyUSD $5,518
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,643
Amount paid for insurance broker fees5518
Insurance broker nameINDIGO INS SERVICES LLC
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4936867
Policy instance 2
Insurance contract or identification number4936867
Number of Individuals Covered112
Total amount of commissions paid to insurance brokerUSD $36,863
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,274,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,863
Insurance broker nameERIC GULKO
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30067873
Policy instance 3
Insurance contract or identification number30067873
Number of Individuals Covered33
Total amount of commissions paid to insurance brokerUSD $453
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $453
Insurance broker nameERIC GULKO
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100004219
Policy instance 2
Insurance contract or identification number40000100004219
Number of Individuals Covered21
Total amount of commissions paid to insurance brokerUSD $1,626
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $10,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,626
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number860056933
Policy instance 3
Insurance contract or identification number860056933
Number of Individuals Covered110
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $2,116
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,116
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number860056932
Policy instance 4
Insurance contract or identification number860056932
Number of Individuals Covered110
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $3,286
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,286
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4936867
Policy instance 5
Insurance contract or identification number4936867
Number of Individuals Covered91
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $4,044
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,044
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number860056931
Policy instance 1
Insurance contract or identification number860056931
Number of Individuals Covered110
Total amount of commissions paid to insurance brokerUSD $2,038
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,038
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number860056933
Policy instance 2
Insurance contract or identification number860056933
Number of Individuals Covered92
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,971
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4936867
Policy instance 1
Insurance contract or identification number4936867
Number of Individuals Covered164
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $23,973
Total amount of fees paid to insurance companyUSD $1,342
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $861,139
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 number860056931
Policy instance 3
Insurance contract or identification number860056931
Number of Individuals Covered107
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,508
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,648
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 number001020
Policy instance 5
Insurance contract or identification number001020
Number of Individuals Covered100
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,860
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,748
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 number40000100004219
Policy instance 6
Insurance contract or identification number40000100004219
Number of Individuals Covered69
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,367
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,112
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 number860056932
Policy instance 4
Insurance contract or identification number860056932
Number of Individuals Covered92
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $2,241
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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