SUPERCON INCORPORATED has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST
401k plan membership statisitcs for SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST
| Measure | Date | Value |
|---|
| 2021: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 39 |
| 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 | 39 |
| 2020: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 40 |
| 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 | 40 |
| 2019: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 40 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 1 |
| Total of all active and inactive participants | 2019-10-01 | 42 |
| 2018: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 41 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 1 |
| Total of all active and inactive participants | 2018-10-01 | 43 |
| 2017: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 41 |
| 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 | 41 |
| 2016: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 40 |
| 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 | 40 |
| 2015: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 39 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 2 |
| Total of all active and inactive participants | 2015-10-01 | 43 |
| 2014: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 39 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 2 |
| Total of all active and inactive participants | 2014-10-01 | 43 |
| 2013: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 42 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 39 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 1 |
| Total of all active and inactive participants | 2013-10-01 | 42 |
| 2012: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 42 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 2 |
| Total of all active and inactive participants | 2012-10-01 | 46 |
| 2011: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 45 |
| Total of all active and inactive participants | 2011-10-01 | 45 |
| 2010: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 38 |
| Total of all active and inactive participants | 2010-10-01 | 38 |
| 2009: SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 39 |
| Total of all active and inactive participants | 2009-10-01 | 39 |
| Measure | Date | Value |
|---|
| 2022 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-09-30 | $175,147 |
| Total income from all sources | 2022-09-30 | $1,350,180 |
| Expenses. Total of all expenses incurred | 2022-09-30 | $1,324,381 |
| Benefits paid (including direct rollovers) | 2022-09-30 | $1,323,806 |
| Total plan assets at end of year | 2022-09-30 | $1,099,583 |
| Total plan assets at beginning of year | 2022-09-30 | $898,637 |
| Total contributions received or receivable from participants | 2022-09-30 | $106,590 |
| Expenses. Other expenses not covered elsewhere | 2022-09-30 | $125 |
| Net income (gross income less expenses) | 2022-09-30 | $25,799 |
| Net plan assets at end of year (total assets less liabilities) | 2022-09-30 | $924,436 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-09-30 | $898,637 |
| Total contributions received or receivable from employer(s) | 2022-09-30 | $1,243,590 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-09-30 | $450 |
| 2021 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2021 401k financial data |
|---|
| Total income from all sources | 2021-09-30 | $595,141 |
| Expenses. Total of all expenses incurred | 2021-09-30 | $1,006,907 |
| Benefits paid (including direct rollovers) | 2021-09-30 | $1,006,332 |
| Total plan assets at end of year | 2021-09-30 | $898,637 |
| Total plan assets at beginning of year | 2021-09-30 | $1,310,403 |
| Total contributions received or receivable from participants | 2021-09-30 | $108,271 |
| Expenses. Other expenses not covered elsewhere | 2021-09-30 | $125 |
| Net income (gross income less expenses) | 2021-09-30 | $-411,766 |
| Net plan assets at end of year (total assets less liabilities) | 2021-09-30 | $898,637 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-09-30 | $1,310,403 |
| Total contributions received or receivable from employer(s) | 2021-09-30 | $486,870 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-09-30 | $450 |
| 2020 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2020 401k financial data |
|---|
| Total income from all sources | 2020-09-30 | $1,897,207 |
| Expenses. Total of all expenses incurred | 2020-09-30 | $1,417,927 |
| Benefits paid (including direct rollovers) | 2020-09-30 | $1,417,802 |
| Total plan assets at end of year | 2020-09-30 | $1,310,403 |
| Total plan assets at beginning of year | 2020-09-30 | $831,123 |
| Total contributions received or receivable from participants | 2020-09-30 | $107,400 |
| Expenses. Other expenses not covered elsewhere | 2020-09-30 | $125 |
| Other income received | 2020-09-30 | $4,018 |
| Net income (gross income less expenses) | 2020-09-30 | $479,280 |
| Net plan assets at end of year (total assets less liabilities) | 2020-09-30 | $1,310,403 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-09-30 | $831,123 |
| Total contributions received or receivable from employer(s) | 2020-09-30 | $1,785,789 |
| 2019 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2019 401k financial data |
|---|
| Total income from all sources | 2019-09-30 | $915,354 |
| Expenses. Total of all expenses incurred | 2019-09-30 | $928,341 |
| Benefits paid (including direct rollovers) | 2019-09-30 | $928,135 |
| Total plan assets at end of year | 2019-09-30 | $831,123 |
| Total plan assets at beginning of year | 2019-09-30 | $844,110 |
| Total contributions received or receivable from participants | 2019-09-30 | $97,093 |
| Expenses. Other expenses not covered elsewhere | 2019-09-30 | $206 |
| Other income received | 2019-09-30 | $7,246 |
| Net income (gross income less expenses) | 2019-09-30 | $-12,987 |
| Net plan assets at end of year (total assets less liabilities) | 2019-09-30 | $831,123 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-09-30 | $844,110 |
| Total contributions received or receivable from employer(s) | 2019-09-30 | $811,015 |
| 2017 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2017 401k financial data |
|---|
| Total income from all sources | 2017-09-30 | $917,570 |
| Expenses. Total of all expenses incurred | 2017-09-30 | $931,077 |
| Benefits paid (including direct rollovers) | 2017-09-30 | $931,007 |
| Total plan assets at end of year | 2017-09-30 | $811,562 |
| Total plan assets at beginning of year | 2017-09-30 | $825,069 |
| Total contributions received or receivable from participants | 2017-09-30 | $119,514 |
| Net income (gross income less expenses) | 2017-09-30 | $-13,507 |
| Net plan assets at end of year (total assets less liabilities) | 2017-09-30 | $811,562 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-09-30 | $825,069 |
| Total contributions received or receivable from employer(s) | 2017-09-30 | $798,056 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-09-30 | $70 |
| 2016 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2016 401k financial data |
|---|
| Total income from all sources | 2016-09-30 | $947,518 |
| Expenses. Total of all expenses incurred | 2016-09-30 | $921,900 |
| Benefits paid (including direct rollovers) | 2016-09-30 | $921,715 |
| Total plan assets at end of year | 2016-09-30 | $825,069 |
| Total plan assets at beginning of year | 2016-09-30 | $799,451 |
| Total contributions received or receivable from participants | 2016-09-30 | $96,646 |
| Other income received | 2016-09-30 | $1,551 |
| Net income (gross income less expenses) | 2016-09-30 | $25,618 |
| Net plan assets at end of year (total assets less liabilities) | 2016-09-30 | $825,069 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-09-30 | $799,451 |
| Total contributions received or receivable from employer(s) | 2016-09-30 | $849,321 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-09-30 | $185 |
| 2015 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2015 401k financial data |
|---|
| Total income from all sources | 2015-09-30 | $935,098 |
| Expenses. Total of all expenses incurred | 2015-09-30 | $884,202 |
| Benefits paid (including direct rollovers) | 2015-09-30 | $883,963 |
| Total plan assets at end of year | 2015-09-30 | $799,451 |
| Total plan assets at beginning of year | 2015-09-30 | $748,555 |
| Total contributions received or receivable from participants | 2015-09-30 | $84,523 |
| Other income received | 2015-09-30 | $1,524 |
| Net income (gross income less expenses) | 2015-09-30 | $50,896 |
| Net plan assets at end of year (total assets less liabilities) | 2015-09-30 | $799,451 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-09-30 | $748,555 |
| Total contributions received or receivable from employer(s) | 2015-09-30 | $849,051 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-09-30 | $239 |
| 2014 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2014 401k financial data |
|---|
| Total income from all sources | 2014-09-30 | $836,838 |
| Expenses. Total of all expenses incurred | 2014-09-30 | $808,799 |
| Benefits paid (including direct rollovers) | 2014-09-30 | $808,580 |
| Total plan assets at end of year | 2014-09-30 | $748,555 |
| Total plan assets at beginning of year | 2014-09-30 | $720,516 |
| Total contributions received or receivable from participants | 2014-09-30 | $60,041 |
| Other income received | 2014-09-30 | $1,661 |
| Net income (gross income less expenses) | 2014-09-30 | $28,039 |
| Net plan assets at end of year (total assets less liabilities) | 2014-09-30 | $748,555 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-09-30 | $720,516 |
| Total contributions received or receivable from employer(s) | 2014-09-30 | $775,136 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-09-30 | $219 |
| 2013 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2013 401k financial data |
|---|
| Total income from all sources | 2013-09-30 | $733,996 |
| Expenses. Total of all expenses incurred | 2013-09-30 | $790,810 |
| Benefits paid (including direct rollovers) | 2013-09-30 | $790,623 |
| Total plan assets at end of year | 2013-09-30 | $720,516 |
| Total plan assets at beginning of year | 2013-09-30 | $777,330 |
| Total contributions received or receivable from participants | 2013-09-30 | $70,177 |
| Other income received | 2013-09-30 | $2,109 |
| Net income (gross income less expenses) | 2013-09-30 | $-56,814 |
| Net plan assets at end of year (total assets less liabilities) | 2013-09-30 | $720,516 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-09-30 | $777,330 |
| Total contributions received or receivable from employer(s) | 2013-09-30 | $661,710 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-09-30 | $187 |
| 2012 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2012 401k financial data |
|---|
| Total income from all sources | 2012-09-30 | $880,019 |
| Expenses. Total of all expenses incurred | 2012-09-30 | $844,370 |
| Benefits paid (including direct rollovers) | 2012-09-30 | $844,180 |
| Total plan assets at end of year | 2012-09-30 | $777,330 |
| Total plan assets at beginning of year | 2012-09-30 | $741,681 |
| Total contributions received or receivable from participants | 2012-09-30 | $66,916 |
| Other income received | 2012-09-30 | $2,173 |
| Net income (gross income less expenses) | 2012-09-30 | $35,649 |
| Net plan assets at end of year (total assets less liabilities) | 2012-09-30 | $777,330 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-09-30 | $741,681 |
| Total contributions received or receivable from employer(s) | 2012-09-30 | $810,930 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-09-30 | $190 |
| 2011 : SUPERCON, INC. VOLUNTARY EMPLOYEE BENEFIT TRUST 2011 401k financial data |
|---|
| Total income from all sources | 2011-09-30 | $881,594 |
| Expenses. Total of all expenses incurred | 2011-09-30 | $799,213 |
| Benefits paid (including direct rollovers) | 2011-09-30 | $799,029 |
| Total plan assets at end of year | 2011-09-30 | $741,681 |
| Total plan assets at beginning of year | 2011-09-30 | $659,300 |
| Total contributions received or receivable from participants | 2011-09-30 | $57,334 |
| Other income received | 2011-09-30 | $1,888 |
| Net income (gross income less expenses) | 2011-09-30 | $82,381 |
| Net plan assets at end of year (total assets less liabilities) | 2011-09-30 | $741,681 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-09-30 | $659,300 |
| Total contributions received or receivable from employer(s) | 2011-09-30 | $822,372 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-09-30 | $184 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $1,733 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,733 |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 11328000 |
| Policy instance | 7 |
| Insurance contract or identification number | 11328000 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $7,685 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $443,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,685 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPM0569F |
| Policy instance | 6 |
| Insurance contract or identification number | GUPM0569F | | Number of Individuals Covered | 42 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $2,393 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,393 |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,960 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $77,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,960 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $286 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $286 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-0569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $1,445 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,445 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $1,236 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,362 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,236 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-0569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-0569F | | Number of Individuals Covered | 38 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1,411 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,411 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0569F | | Number of Individuals Covered | 38 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $457 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $457 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0569F | | Number of Individuals Covered | 38 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1,184 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,184 |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $7,660 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $435,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,660 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUPM0569F |
| Policy instance | 6 |
| Insurance contract or identification number | GUPM0569F | | Number of Individuals Covered | 40 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1,254 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,254 |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $1,742 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,742 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-0569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,599 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,990 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,599 |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $8,040 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $424,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,040 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,061 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,061 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,245 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,455 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,245 |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,586 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,586 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $930 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $930 |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $7,500 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $382,655 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,500 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-0569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,416 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,416 |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,624 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,624 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $1,176 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,176 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0569F | | Number of Individuals Covered | 38 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $873 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $7,220 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $369,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-0569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,328 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,120 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,635 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 6 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $351 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,505 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $351 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $10,368 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $373,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,368 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0569F | | Number of Individuals Covered | 41 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,046 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,463 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,046 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-0569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-0569F | | Number of Individuals Covered | 43 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,693 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,928 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,693 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0569F | | Number of Individuals Covered | 43 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $1,350 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,350 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $2,113 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,175 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,113 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,973 | | 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 $31,558 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,973 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0569F | | Number of Individuals Covered | 41 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,275 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,275 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-0569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-0569F | | Number of Individuals Covered | 41 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,663 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,663 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG0569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,061 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,611 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,061 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 6 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $327 | | 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 $19,947 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $327 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $9,564 | | 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 $395,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,564 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $1,979 | | 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 $31,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,979 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 6 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $672 | | 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 $19,439 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $672 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $9,436 | | 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 $243,023 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,436 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-569F | | Number of Individuals Covered | 40 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $1,306 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,059 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,306 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG-569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG-569F | | Number of Individuals Covered | 40 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $1,242 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,242 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG-569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG-569F | | Number of Individuals Covered | 39 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $966 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $966 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG-569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG-569F | | Number of Individuals Covered | 43 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $1,326 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,326 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 6 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $1,008 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,008 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $10,080 | | 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 $294,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,080 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG-569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG-569F | | Number of Individuals Covered | 42 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $981 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,810 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $981 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-569F | | Number of Individuals Covered | 43 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $1,247 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,247 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $2,024 | | 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 $33,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,024 | | Insurance broker name | HARBOR INSURANCE GROUP LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-569F | | Number of Individuals Covered | 42 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $1,139 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00470565 |
| Policy instance | 7 |
| Insurance contract or identification number | 00470565 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $2,281 | | 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 $32,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG-569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG-569F | | Number of Individuals Covered | 42 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $1,230 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,301 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 6 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $1,008 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $9,520 | | 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 $255,931 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG-569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG-569F | | Number of Individuals Covered | 42 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $939 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8061307 |
| Policy instance | 1 |
| Insurance contract or identification number | 8061307 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $297 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG-569F |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG-569F | | Number of Individuals Covered | 36 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $1,145 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD-569F |
| Policy instance | 3 |
| Insurance contract or identification number | GLTD-569F | | Number of Individuals Covered | 36 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $1,037 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00470565 |
| Policy instance | 7 |
| Insurance contract or identification number | 00470565 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2011-09-30 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 6 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $756 | | 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 $28,410 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C002241638C01 |
| Policy instance | 5 |
| Insurance contract or identification number | C002241638C01 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $8,708 | | 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 $235,578 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG-569F |
| Policy instance | 4 |
| Insurance contract or identification number | GUG-569F | | Number of Individuals Covered | 36 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $868 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 8010993 |
| Policy instance | 1 |
| Insurance contract or identification number | 8010993 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | Total amount of commissions paid to insurance broker | USD $1,816 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
