401k Plan data: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION plan

MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 401k Plan overview

Plan Name	MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION
Plan identification number	517

MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

THE MCLEAN HOSPITAL CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: THE MCLEAN HOSPITAL CORPORATION

Employer identification number (EIN): 042697981

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
517 2022-01-01 BETH ROHLFING 2023-07-21
517 2021-01-01 BETH ROHLFING 2022-07-14
517 2020-01-01 CHRISTINE ZOTTOLI 2021-07-13
517 2019-01-01 CHRISTINE ZOTTOLI 2020-07-28
517 2018-01-01 CHRISTINE ZOTTOLI 2019-10-08
517 2017-01-01 CHRISTINE ZOTTOLI 2018-07-26
517 2016-01-01 DONNA CLANCY
517 2015-01-01 PAUL CHANEY
517 2014-01-01 PAUL CHANEY DONNA CLANCY 2015-07-29
517 2013-01-01 PAUL CHANEY AMY VACCHINA 2014-07-23
517 2012-01-01 PAUL CHANEY AMY VACCHINA 2013-07-29
517 2011-01-01 PAUL CHANEY AMY VACCHINA 2012-11-01
517 2009-01-01 PAUL CHANEY AMY VACCHINA 2010-07-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
517	2022-01-01	BETH ROHLFING	2023-07-21
517	2021-01-01	BETH ROHLFING	2022-07-14
517	2020-01-01	CHRISTINE ZOTTOLI	2021-07-13
517	2019-01-01	CHRISTINE ZOTTOLI	2020-07-28
517	2018-01-01	CHRISTINE ZOTTOLI	2019-10-08
517	2017-01-01	CHRISTINE ZOTTOLI	2018-07-26
517	2016-01-01	DONNA CLANCY
517	2015-01-01	PAUL CHANEY
517	2014-01-01	PAUL CHANEY		DONNA CLANCY	2015-07-29
517	2013-01-01	PAUL CHANEY		AMY VACCHINA	2014-07-23
517	2012-01-01	PAUL CHANEY		AMY VACCHINA	2013-07-29
517	2011-01-01	PAUL CHANEY		AMY VACCHINA	2012-11-01
517	2009-01-01	PAUL CHANEY		AMY VACCHINA	2010-07-23

Plan Statistics for MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION

401k plan membership statisitcs for MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION

Measure Date Value
2016: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2016 401k membership
Total participants, beginning-of-year 2016-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 92
Total of all active and inactive participants 2016-01-01 92
2015: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2015 401k membership
Total participants, beginning-of-year 2015-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 106
Total of all active and inactive participants 2015-01-01 106
2014: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2014 401k membership
Total participants, beginning-of-year 2014-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 104
Total of all active and inactive participants 2014-01-01 104
2013: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2013 401k membership
Total participants, beginning-of-year 2013-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 115
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 115
2012: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2012 401k membership
Total participants, beginning-of-year 2012-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 130
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 130
2011: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2011 401k membership
Total participants, beginning-of-year 2011-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 140
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 140
2009: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2009 401k membership
Total participants, beginning-of-year 2009-01-01 166
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 0
Number of retired or separated participants receiving benefits 2009-01-01 157
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 157

Measure	Date	Value
2016: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2016 401k membership
Total participants, beginning-of-year	2016-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	92
Total of all active and inactive participants	2016-01-01	92
2015: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2015 401k membership
Total participants, beginning-of-year	2015-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	106
Total of all active and inactive participants	2015-01-01	106
2014: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2014 401k membership
Total participants, beginning-of-year	2014-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	104
Total of all active and inactive participants	2014-01-01	104
2013: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2013 401k membership
Total participants, beginning-of-year	2013-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	115
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	115
2012: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2012 401k membership
Total participants, beginning-of-year	2012-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	130
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	130
2011: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2011 401k membership
Total participants, beginning-of-year	2011-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	140
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	140
2009: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2009 401k membership
Total participants, beginning-of-year	2009-01-01	166
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	0
Number of retired or separated participants receiving benefits	2009-01-01	157
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	157

Financial Data on MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION

Measure	Date	Value
2016 : MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$52,511
Total unrealized appreciation/depreciation of assets	2016-12-31	$52,511
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$14,641
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$18,762
Total income from all sources (including contributions)	2016-12-31	$52,845
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$269,757
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$266,175
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$1,666,839
Value of total assets at beginning of year	2016-12-31	$1,887,872
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$3,582
Total interest from all sources	2016-12-31	$334
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$14,641
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$18,762
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-216,912
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,652,198
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,869,110
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,666,839
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,887,872
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$334
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$266,175
Contract administrator fees	2016-12-31	$3,582
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	BDO USA, LLP
Accountancy firm EIN	2016-12-31	135381590
2015 : MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$-108,850
Total unrealized appreciation/depreciation of assets	2015-12-31	$-108,850
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$18,762
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$20,937
Total income from all sources (including contributions)	2015-12-31	$-108,147
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$261,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$257,254
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$1,887,872
Value of total assets at beginning of year	2015-12-31	$2,260,124
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$4,676
Total interest from all sources	2015-12-31	$703
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$18,762
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$20,937
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-370,077
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,869,110
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,239,187
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,887,872
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,260,124
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$703
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$257,254
Contract administrator fees	2015-12-31	$4,676
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	BDO USA, LLP
Accountancy firm EIN	2015-12-31	135381590
2014 : MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$164,746
Total unrealized appreciation/depreciation of assets	2014-12-31	$164,746
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$20,937
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$17,998
Total income from all sources (including contributions)	2014-12-31	$166,248
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$1,113,531
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,072,334
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$2,260,124
Value of total assets at beginning of year	2014-12-31	$3,204,468
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$41,197
Total interest from all sources	2014-12-31	$1,502
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$20,937
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$17,998
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-947,283
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,239,187
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$3,186,470
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,260,124
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$3,204,468
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$1,502
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,072,334
Contract administrator fees	2014-12-31	$41,197
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	FEELEY & DRISCOLL PC
Accountancy firm EIN	2014-12-31	042684828
2013 : MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$522,073
Total unrealized appreciation/depreciation of assets	2013-12-31	$522,073
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$17,998
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$29,555
Total income from all sources (including contributions)	2013-12-31	$524,055
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,290,703
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,211,370
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$3,204,468
Value of total assets at beginning of year	2013-12-31	$3,982,673
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$79,333
Total interest from all sources	2013-12-31	$1,982
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$17,998
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$29,555
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-766,648
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$3,186,470
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,953,118
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$3,204,468
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$3,982,673
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$1,982
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,211,370
Contract administrator fees	2013-12-31	$79,333
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	FEELEY & DRISCOLL PC
Accountancy firm EIN	2013-12-31	042684828
2012 : MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$482,997
Total unrealized appreciation/depreciation of assets	2012-12-31	$482,997
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$29,555
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$863,365
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$402,900
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$376,000
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$376,000
Value of total assets at end of year	2012-12-31	$3,982,673
Value of total assets at beginning of year	2012-12-31	$3,492,653
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$26,900
Total interest from all sources	2012-12-31	$4,368
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$29,555
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$460,465
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,953,118
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$3,492,653
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$3,982,673
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$3,492,653
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$4,368
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$376,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$376,000
Contract administrator fees	2012-12-31	$26,900
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	FEELEY & DRISCOLL PC
Accountancy firm EIN	2012-12-31	042684828
2011 : MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$-42,175
Total unrealized appreciation/depreciation of assets	2011-12-31	$-42,175
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$435,578
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$416,944
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$403,000
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$403,000
Value of total assets at end of year	2011-12-31	$3,492,653
Value of total assets at beginning of year	2011-12-31	$3,474,019
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$13,944
Total interest from all sources	2011-12-31	$74,753
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$18,634
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$3,492,653
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,474,019
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$13,944
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$3,492,653
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$3,474,019
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$74,753
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$403,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$403,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	FEELEY & DRISCOLL PC
Accountancy firm EIN	2011-12-31	042684828
2010 : MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$237,995
Total unrealized appreciation/depreciation of assets	2010-12-31	$237,995
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$740,928
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$428,415
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$412,000
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$412,000
Value of total assets at end of year	2010-12-31	$3,474,019
Value of total assets at beginning of year	2010-12-31	$3,161,506
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$16,415
Total interest from all sources	2010-12-31	$90,933
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$312,513
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,474,019
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,161,506
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$16,415
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$3,474,019
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$3,161,506
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$90,933
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$412,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$412,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	FEELEY & DRISCOLL P.C.
Accountancy firm EIN	2010-12-31	042684828

Form 5500 Responses for MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION

2016: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MEDICAL BENEFITS PLAN FOR RETIREES OF THE MCLEAN HOSPITAL CORPORATION 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

94092

Policy instance

Insurance contract or identification number	94092
Number of Individuals Covered	6
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $33,835
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

94092

Policy instance

Insurance contract or identification number	94092
Number of Individuals Covered	6
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $36,308
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

94092

Policy instance

Insurance contract or identification number	94092
Number of Individuals Covered	9
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $45,526
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

94092

Policy instance

Insurance contract or identification number	94092
Number of Individuals Covered	9
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $36,540
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

94092

Policy instance

Insurance contract or identification number	94092
Number of Individuals Covered	15
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $43,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	THE MCLEAN HOSPITAL CORPORATION
Employer identification number (EIN):	042697981
NAIC Classification:	622000
NAIC Description:	Hospitals