401k Plan data: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS plan

FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 401k Plan overview

Plan Name	FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS
Plan identification number	501

FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS Benefits

401k Plan Type	Welfare 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)

401k Sponsoring company profile

FRANCISCAN CHILDREN'S has sponsored the creation of one or more 401k plans.

Company Name: FRANCISCAN CHILDREN'S

Employer identification number (EIN): 042156082

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-10-01 DANIEL LEFAIVRE 2023-12-20
501 2021-10-01 HARRY DIEUVEUIL 2023-04-21
501 2020-10-01 SUZANNE PARSONS 2022-04-26
501 2019-10-01 MARY KOHANSKI 2021-02-25
501 2018-10-01 MARY KOHANSKI 2020-04-03
501 2018-10-01 MARY KOHANSKI 2021-02-25
501 2017-10-01 MARY KOHANSKI 2019-07-10
501 2017-10-01 MARY KOHANSKI 2021-02-25
501 2016-10-01
501 2015-10-01 ALEX DENUCCI ALEX DENUCCI 2017-07-13
501 2014-10-01 ALEX DENUCCI ALEX DENUCCI 2016-07-07
501 2013-10-01 ALEX DENUCCI ALEX DENUCCI 2015-04-29
501 2012-10-01 PETER CURTIS PETER CURTIS 2014-07-15
501 2011-10-01 ALEX DENUCCI ALEX DENUCCI 2014-01-29
501 2010-10-01 ALEXANDER DENUCCI ALEXANDER DENUCCI 2014-01-30
501 2009-10-01 ALEX DENUCCI ALEX DENUCCI 2014-01-30
501 2008-10-01 ALEX DENUCCI ALEX DENUCCI 2014-01-30
501 2007-10-01 ALEX DENUCCI ALEX DENUCCI 2014-01-30
501 2006-10-01 ALEX DENUCCI ALEX DENUCCI 2013-01-30

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-10-01	DANIEL LEFAIVRE	2023-12-20
501	2021-10-01	HARRY DIEUVEUIL	2023-04-21
501	2020-10-01	SUZANNE PARSONS	2022-04-26
501	2019-10-01	MARY KOHANSKI	2021-02-25
501	2018-10-01	MARY KOHANSKI	2020-04-03
501	2018-10-01	MARY KOHANSKI	2021-02-25
501	2017-10-01	MARY KOHANSKI	2019-07-10
501	2017-10-01	MARY KOHANSKI	2021-02-25
501	2016-10-01
501	2015-10-01	ALEX DENUCCI		ALEX DENUCCI	2017-07-13
501	2014-10-01	ALEX DENUCCI		ALEX DENUCCI	2016-07-07
501	2013-10-01	ALEX DENUCCI		ALEX DENUCCI	2015-04-29
501	2012-10-01	PETER CURTIS		PETER CURTIS	2014-07-15
501	2011-10-01	ALEX DENUCCI		ALEX DENUCCI	2014-01-29
501	2010-10-01	ALEXANDER DENUCCI		ALEXANDER DENUCCI	2014-01-30
501	2009-10-01	ALEX DENUCCI		ALEX DENUCCI	2014-01-30
501	2008-10-01	ALEX DENUCCI		ALEX DENUCCI	2014-01-30
501	2007-10-01	ALEX DENUCCI		ALEX DENUCCI	2014-01-30
501	2006-10-01	ALEX DENUCCI		ALEX DENUCCI	2013-01-30

Plan Statistics for FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS

401k plan membership statisitcs for FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS

Measure Date Value
2022: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2022 401k membership
Total participants, beginning-of-year 2022-10-01 530
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 573
Number of retired or separated participants receiving benefits 2022-10-01 0
Number of other retired or separated participants entitled to future benefits 2022-10-01 0
Total of all active and inactive participants 2022-10-01 573
Number of employers contributing to the scheme 2022-10-01 0
2021: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2021 401k membership
Total participants, beginning-of-year 2021-10-01 555
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 530
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 530
Number of employers contributing to the scheme 2021-10-01 0
2020: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2020 401k membership
Total participants, beginning-of-year 2020-10-01 550
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 555
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 555
Number of employers contributing to the scheme 2020-10-01 0
2019: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2019 401k membership
Total participants, beginning-of-year 2019-10-01 325
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 550
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 550
Number of employers contributing to the scheme 2019-10-01 0
2018: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2018 401k membership
Total participants, beginning-of-year 2018-10-01 392
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 325
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 325
Number of employers contributing to the scheme 2018-10-01 0
2017: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2017 401k membership
Total participants, beginning-of-year 2017-10-01 392
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 358
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 358
Number of employers contributing to the scheme 2017-10-01 0
2016: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2016 401k membership
Total participants, beginning-of-year 2016-10-01 559
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 392
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 392
2015: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2015 401k membership
Total participants, beginning-of-year 2015-10-01 541
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 559
Total of all active and inactive participants 2015-10-01 559
2014: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2014 401k membership
Total participants, beginning-of-year 2014-10-01 501
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 541
Total of all active and inactive participants 2014-10-01 541
2013: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2013 401k membership
Total participants, beginning-of-year 2013-10-01 663
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 501
Total of all active and inactive participants 2013-10-01 501
Total participants 2013-10-01 501
2012: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2012 401k membership
Total participants, beginning-of-year 2012-10-01 465
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 663
Total of all active and inactive participants 2012-10-01 663
Total participants 2012-10-01 663
2011: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2011 401k membership
Total participants, beginning-of-year 2011-10-01 482
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 465
Total of all active and inactive participants 2011-10-01 465
2010: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2010 401k membership
Total participants, beginning-of-year 2010-10-01 536
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 482
Total of all active and inactive participants 2010-10-01 482
2009: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2009 401k membership
Total participants, beginning-of-year 2009-10-01 453
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 536
Total of all active and inactive participants 2009-10-01 536
2008: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2008 401k membership
Total participants, beginning-of-year 2008-10-01 454
Total number of active participants reported on line 7a of the Form 5500 2008-10-01 453
Total of all active and inactive participants 2008-10-01 453
2007: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2007 401k membership
Total participants, beginning-of-year 2007-10-01 488
Total number of active participants reported on line 7a of the Form 5500 2007-10-01 454
Total of all active and inactive participants 2007-10-01 454
2006: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2006 401k membership
Total participants, beginning-of-year 2006-10-01 493
Total number of active participants reported on line 7a of the Form 5500 2006-10-01 488
Total of all active and inactive participants 2006-10-01 488

Measure	Date	Value
2022: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2022 401k membership
Total participants, beginning-of-year	2022-10-01	530
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	573
Number of retired or separated participants receiving benefits	2022-10-01	0
Number of other retired or separated participants entitled to future benefits	2022-10-01	0
Total of all active and inactive participants	2022-10-01	573
Number of employers contributing to the scheme	2022-10-01	0
2021: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2021 401k membership
Total participants, beginning-of-year	2021-10-01	555
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	530
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	530
Number of employers contributing to the scheme	2021-10-01	0
2020: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2020 401k membership
Total participants, beginning-of-year	2020-10-01	550
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	555
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	555
Number of employers contributing to the scheme	2020-10-01	0
2019: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2019 401k membership
Total participants, beginning-of-year	2019-10-01	325
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	550
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	550
Number of employers contributing to the scheme	2019-10-01	0
2018: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2018 401k membership
Total participants, beginning-of-year	2018-10-01	392
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	325
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	325
Number of employers contributing to the scheme	2018-10-01	0
2017: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2017 401k membership
Total participants, beginning-of-year	2017-10-01	392
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	358
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	358
Number of employers contributing to the scheme	2017-10-01	0
2016: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2016 401k membership
Total participants, beginning-of-year	2016-10-01	559
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	392
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	392
2015: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2015 401k membership
Total participants, beginning-of-year	2015-10-01	541
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	559
Total of all active and inactive participants	2015-10-01	559
2014: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2014 401k membership
Total participants, beginning-of-year	2014-10-01	501
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	541
Total of all active and inactive participants	2014-10-01	541
2013: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2013 401k membership
Total participants, beginning-of-year	2013-10-01	663
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	501
Total of all active and inactive participants	2013-10-01	501
Total participants	2013-10-01	501
2012: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2012 401k membership
Total participants, beginning-of-year	2012-10-01	465
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	663
Total of all active and inactive participants	2012-10-01	663
Total participants	2012-10-01	663
2011: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2011 401k membership
Total participants, beginning-of-year	2011-10-01	482
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	465
Total of all active and inactive participants	2011-10-01	465
2010: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2010 401k membership
Total participants, beginning-of-year	2010-10-01	536
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	482
Total of all active and inactive participants	2010-10-01	482
2009: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2009 401k membership
Total participants, beginning-of-year	2009-10-01	453
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	536
Total of all active and inactive participants	2009-10-01	536
2008: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2008 401k membership
Total participants, beginning-of-year	2008-10-01	454
Total number of active participants reported on line 7a of the Form 5500	2008-10-01	453
Total of all active and inactive participants	2008-10-01	453
2007: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2007 401k membership
Total participants, beginning-of-year	2007-10-01	488
Total number of active participants reported on line 7a of the Form 5500	2007-10-01	454
Total of all active and inactive participants	2007-10-01	454
2006: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2006 401k membership
Total participants, beginning-of-year	2006-10-01	493
Total number of active participants reported on line 7a of the Form 5500	2006-10-01	488
Total of all active and inactive participants	2006-10-01	488

Form 5500 Responses for FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS

2022: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	Submission has been amended	Yes
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	Yes
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2011: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2010: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes
2009: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2008: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-10-01	Plan benefit arrangement – Insurance	Yes
2007: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2007 form 5500 responses
2007-10-01	Type of plan entity	Single employer plan
2007-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-10-01	Plan benefit arrangement – Insurance	Yes
2006: FRANCISCAN HOSPITAL FOR CHILDREN WRAP PLAN BENEFITS 2006 form 5500 responses
2006-10-01	Type of plan entity	Single employer plan
2006-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

10019000

Policy instance

Insurance contract or identification number	10019000
Number of Individuals Covered	100
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $18,872
Total amount of fees paid to insurance company	USD $14,769
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $892,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,872
Amount paid for insurance broker fees	14769
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

10017000

Policy instance

Insurance contract or identification number	10017000
Number of Individuals Covered	413
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $40,325
Total amount of fees paid to insurance company	USD $41,949
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,958,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,325
Amount paid for insurance broker fees	41949
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

886205G

Policy instance

Insurance contract or identification number	886205G
Number of Individuals Covered	573
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,914
Total amount of fees paid to insurance company	USD $18,357
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $205,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,914
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	267
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,269
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,269
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

15303

Policy instance

Insurance contract or identification number	15303
Number of Individuals Covered	505
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,974
Total amount of fees paid to insurance company	USD $2,560
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $245,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,974
Amount paid for insurance broker fees	2560
Additional information about fees paid to insurance broker	OTHER FEES
Insurance broker organization code?	3

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

10017000

Policy instance

Insurance contract or identification number	10017000
Number of Individuals Covered	354
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $44,262
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,754,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,262
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	244
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $675
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $675
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

886205G

Policy instance

Insurance contract or identification number	886205G
Number of Individuals Covered	530
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $14,969
Total amount of fees paid to insurance company	USD $20,555
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $207,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,969
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

10019000

Policy instance

Insurance contract or identification number	10019000
Number of Individuals Covered	106
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,888
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $969,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,888
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

15303

Policy instance

Insurance contract or identification number	15303
Number of Individuals Covered	476
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,759
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $234,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,759
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

886205G

Policy instance

Insurance contract or identification number	886205G
Number of Individuals Covered	555
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $15,771
Total amount of fees paid to insurance company	USD $27,671
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $221,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	17540
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	257
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $1,159
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,159
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957868

Policy instance

Insurance contract or identification number	4957868
Number of Individuals Covered	485
Insurance policy start date	2020-10-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $10,117
Total amount of fees paid to insurance company	USD $16,118
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $10,117
Amount paid for insurance broker fees	16118
Additional information about fees paid to insurance broker	OTHER COMMISSION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	217
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $1,025
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,025
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957868

Policy instance

Insurance contract or identification number	4957868
Number of Individuals Covered	497
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $80,599
Total amount of fees paid to insurance company	USD $19,260
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $80,599
Amount paid for insurance broker fees	19260
Additional information about fees paid to insurance broker	OTHER COMMISSION
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

886205G

Policy instance

Insurance contract or identification number	886205G
Number of Individuals Covered	550
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,768
Total amount of fees paid to insurance company	USD $15,948
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $227,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	15948
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7315443

Policy instance

Insurance contract or identification number	E7315443
Number of Individuals Covered	62
Insurance policy start date	2018-10-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,499
Total amount of fees paid to insurance company	USD $449
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $17,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $786
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

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

Policy contract number

700198

Policy instance

Insurance contract or identification number	700198
Number of Individuals Covered	577
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $5,820
Total amount of fees paid to insurance company	USD $1,332
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $60,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,820
Amount paid for insurance broker fees	1332
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957868

Policy instance

Insurance contract or identification number	4957868
Number of Individuals Covered	536
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $79,079
Total amount of fees paid to insurance company	USD $21,754
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $79,079
Amount paid for insurance broker fees	21754
Additional information about fees paid to insurance broker	OTHER COMMISSION NON-MONETARY COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	221
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $1,096
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,096
Insurance broker organization code?	3

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

Policy contract number

700200

Policy instance

Insurance contract or identification number	700200
Number of Individuals Covered	711
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $24,025
Total amount of fees paid to insurance company	USD $4,107
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $252,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,034
Amount paid for insurance broker fees	4052
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957868

Policy instance

Insurance contract or identification number	4957868
Number of Individuals Covered	574
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $75,969
Total amount of fees paid to insurance company	USD $14,580
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $75,969
Amount paid for insurance broker fees	14580
Additional information about fees paid to insurance broker	OTHER COMMISSION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	207
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $903
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $903
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7315443

Policy instance

Insurance contract or identification number	E7315443
Number of Individuals Covered	69
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $11,846
Total amount of fees paid to insurance company	USD $2,353
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $69,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,210
Amount paid for insurance broker fees	1192
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

013083

Policy instance

Insurance contract or identification number	013083
Number of Individuals Covered	546
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,529
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $216,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,529
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	87
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $632
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $632
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957868

Policy instance

Insurance contract or identification number	4957868
Number of Individuals Covered	525
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $92,623
Total amount of fees paid to insurance company	USD $37,678
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $92,623
Amount paid for insurance broker fees	37678
Additional information about fees paid to insurance broker	BONUSES AND PERSISTENCY COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

700199

Policy instance

Insurance contract or identification number	700199
Number of Individuals Covered	45
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,522
Total amount of fees paid to insurance company	USD $487
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,522
Amount paid for insurance broker fees	487
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7315443

Policy instance

Insurance contract or identification number	E7315443
Number of Individuals Covered	59
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $7,529
Total amount of fees paid to insurance company	USD $771
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $51,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,765
Amount paid for insurance broker fees	440
Additional information about fees paid to insurance broker	BONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	JEFFREY ANTHONY MANZI

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1030379

Policy instance

Insurance contract or identification number	1030379
Number of Individuals Covered	541
Insurance policy start date	2014-10-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,905
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,905
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

700198

Policy instance

Insurance contract or identification number	700198
Number of Individuals Covered	486
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $5,072
Total amount of fees paid to insurance company	USD $951
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $38,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,072
Amount paid for insurance broker fees	951
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

700200

Policy instance

Insurance contract or identification number	700200
Number of Individuals Covered	393
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,988
Total amount of fees paid to insurance company	USD $844
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,988
Amount paid for insurance broker fees	844
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

700201

Policy instance

Insurance contract or identification number	700201
Number of Individuals Covered	44
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $2,742
Total amount of fees paid to insurance company	USD $407
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	LIFESYTLE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,742
Amount paid for insurance broker fees	407
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

029950

Policy instance

Insurance contract or identification number	029950
Number of Individuals Covered	106
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $9,784
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $666,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,784
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1030379

Policy instance

Insurance contract or identification number	1030379
Number of Individuals Covered	501
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $13,570
Total amount of fees paid to insurance company	USD $779
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $193,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,570
Amount paid for insurance broker fees	779
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

029951

Policy instance

Insurance contract or identification number	029951
Number of Individuals Covered	104
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $8,932
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $608,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,932
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	3
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $301
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $301
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	170
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $14,857
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,011,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,857
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	139
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $13,572
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $924,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,572
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	2
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $618
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $618
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7315443

Policy instance

Insurance contract or identification number	E7315443
Number of Individuals Covered	59
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $7,529
Total amount of fees paid to insurance company	USD $771
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $51,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,765
Amount paid for insurance broker fees	440
Additional information about fees paid to insurance broker	BONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?	3
Insurance broker name	JEFFREY ANTHONY MANZI

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	69
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $534
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $534
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1030379

Policy instance

Insurance contract or identification number	1030379
Number of Individuals Covered	663
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $20,868
Total amount of fees paid to insurance company	USD $23,786
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $397,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,868
Amount paid for insurance broker fees	23786
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )

Policy contract number

30035554

Policy instance

Insurance contract or identification number	30035554
Number of Individuals Covered	45
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $413
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $413
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

029951

Policy instance

Insurance contract or identification number	029951
Number of Individuals Covered	90
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $6,934
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $453,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,934
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

029950

Policy instance

Insurance contract or identification number	029950
Number of Individuals Covered	100
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $9,095
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $594,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,095
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	5
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $128
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $128
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	3
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $336
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $336
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	125
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $11,255
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $735,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,255
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	150
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $15,648
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,023,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,648
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	117
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $13,123
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $872,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	2
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $185
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

029951

Policy instance

Insurance contract or identification number	029951
Number of Individuals Covered	0
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

029950

Policy instance

Insurance contract or identification number	029950
Number of Individuals Covered	0
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000626

Policy instance

Insurance contract or identification number	000626
Number of Individuals Covered	444
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $5,243
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	0
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $30
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

133004

Policy instance

Insurance contract or identification number	133004
Number of Individuals Covered	466
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $808
Total amount of fees paid to insurance company	USD $95
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	346
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $30,790
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,046,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	356
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $31,947
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,180,023
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

000626

Policy instance

Insurance contract or identification number	000626
Number of Individuals Covered	444
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $5,243
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

133004

Policy instance

Insurance contract or identification number	133004
Number of Individuals Covered	466
Insurance policy start date	2010-10-01
Insurance policy end date	2011-10-01
Total amount of commissions paid to insurance broker	USD $808
Total amount of fees paid to insurance company	USD $95
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	126
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $13,651
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $908,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

133004

Policy instance

Insurance contract or identification number	133004
Number of Individuals Covered	461
Insurance policy start date	2009-10-01
Insurance policy end date	2010-10-01
Total amount of commissions paid to insurance broker	USD $653
Total amount of fees paid to insurance company	USD $61
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $653
Amount paid for insurance broker fees	61
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	335
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $25,678
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,756,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,678
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05754751

Policy instance

Insurance contract or identification number	TM05754751
Number of Individuals Covered	536
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $3,887
Total amount of fees paid to insurance company	USD $2,528
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,887
Amount paid for insurance broker fees	2528
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	151
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $14,690
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,005,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,690
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	160
Insurance policy start date	2008-10-01
Insurance policy end date	2009-09-30
Total amount of commissions paid to insurance broker	USD $17,405
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $942,923
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

006508

Policy instance

Insurance contract or identification number	006508
Number of Individuals Covered	381
Insurance policy start date	2008-10-01
Insurance policy end date	2009-09-30
Total amount of commissions paid to insurance broker	USD $5,377
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

133004

Policy instance

Insurance contract or identification number	133004
Number of Individuals Covered	435
Insurance policy start date	2008-10-01
Insurance policy end date	2009-10-01
Total amount of commissions paid to insurance broker	USD $1,098
Total amount of fees paid to insurance company	USD $52
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,098
Amount paid for insurance broker fees	52
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

511433

Policy instance

Insurance contract or identification number	511433
Number of Individuals Covered	28
Insurance policy start date	2008-10-01
Insurance policy end date	2009-10-01
Total amount of commissions paid to insurance broker	USD $5,288
Total amount of fees paid to insurance company	USD $264
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,288
Amount paid for insurance broker fees	264
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	293
Insurance policy start date	2008-10-01
Insurance policy end date	2009-09-30
Total amount of commissions paid to insurance broker	USD $24,051
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,312,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	160
Insurance policy start date	2008-10-01
Insurance policy end date	2009-09-30
Total amount of commissions paid to insurance broker	USD $17,405
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $942,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,405
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	293
Insurance policy start date	2008-10-01
Insurance policy end date	2009-09-30
Total amount of commissions paid to insurance broker	USD $24,051
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,312,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,051
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

006508

Policy instance

Insurance contract or identification number	006508
Number of Individuals Covered	381
Insurance policy start date	2008-10-01
Insurance policy end date	2009-09-30
Total amount of commissions paid to insurance broker	USD $5,377
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,377
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

006508

Policy instance

Insurance contract or identification number	006508
Number of Individuals Covered	439
Insurance policy start date	2007-10-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $5,687
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,687
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	176
Insurance policy start date	2007-10-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $17,792
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,084,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,792
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	278
Insurance policy start date	2007-10-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $20,526
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,407,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	176
Insurance policy start date	2007-10-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $17,792
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,084,983
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

006508

Policy instance

Insurance contract or identification number	006508
Number of Individuals Covered	439
Insurance policy start date	2007-10-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $5,687
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $170,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H10169

Policy instance

Insurance contract or identification number	H10169
Number of Individuals Covered	449
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $818
Total amount of fees paid to insurance company	USD $230
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $818
Amount paid for insurance broker fees	230
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H10169

Policy instance

Insurance contract or identification number	H10169
Number of Individuals Covered	422
Insurance policy start date	2008-06-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $356
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $356
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	278
Insurance policy start date	2007-10-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $20,526
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,407,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,526
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	162
Insurance policy start date	2006-10-01
Insurance policy end date	2007-09-30
Total amount of commissions paid to insurance broker	USD $12,566
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $787,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	326
Insurance policy start date	2006-10-01
Insurance policy end date	2007-09-30
Total amount of commissions paid to insurance broker	USD $25,819
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,628,603
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

006508

Policy instance

Insurance contract or identification number	006508
Number of Individuals Covered	325
Insurance policy start date	2006-10-01
Insurance policy end date	2007-09-30
Total amount of commissions paid to insurance broker	USD $5,861
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H10169

Policy instance

Insurance contract or identification number	H10169
Number of Individuals Covered	456
Insurance policy start date	2006-06-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $970
Total amount of fees paid to insurance company	USD $162
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $970
Amount paid for insurance broker fees	162
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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

Policy contract number

006508

Policy instance

Insurance contract or identification number	006508
Number of Individuals Covered	325
Insurance policy start date	2006-10-01
Insurance policy end date	2007-09-30
Total amount of commissions paid to insurance broker	USD $5,861
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,861
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

060977

Policy instance

Insurance contract or identification number	060977
Number of Individuals Covered	326
Insurance policy start date	2006-10-01
Insurance policy end date	2007-09-30
Total amount of commissions paid to insurance broker	USD $25,819
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,628,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,819
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

037222

Policy instance

Insurance contract or identification number	037222
Number of Individuals Covered	162
Insurance policy start date	2006-10-01
Insurance policy end date	2007-09-30
Total amount of commissions paid to insurance broker	USD $12,566
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $787,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,566
Insurance broker organization code?	3
Insurance broker name	COMPREHENSIVE INSURANCE PROVIDERS

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Company Name:	FRANCISCAN CHILDREN'S
Employer identification number (EIN):	042156082
NAIC Classification:	622000
NAIC Description:	Hospitals