401k Plan data: BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN plan

BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN
Plan identification number	502

BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BOYLE SHAUGHNESSY LAW PC has sponsored the creation of one or more 401k plans.

Company Name: BOYLE SHAUGHNESSY LAW PC

Employer identification number (EIN): 043254479

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-07-01 KAREN BENDER 2022-12-06
502 2020-07-01 KAREN BENDER 2022-01-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-07-01	KAREN BENDER	2022-12-06
502	2020-07-01	KAREN BENDER	2022-01-17

Plan Statistics for BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN

401k plan membership statisitcs for BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN

Measure Date Value
2021: BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 112
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 99
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 99
Number of employers contributing to the scheme 2021-07-01 0
2020: BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 105
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 110
Number of retired or separated participants receiving benefits 2020-07-01 1
Number of other retired or separated participants entitled to future benefits 2020-07-01 2
Total of all active and inactive participants 2020-07-01 113
Number of employers contributing to the scheme 2020-07-01 0

Measure	Date	Value
2021: BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	112
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	99
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	99
Number of employers contributing to the scheme	2021-07-01	0
2020: BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	105
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	110
Number of retired or separated participants receiving benefits	2020-07-01	1
Number of other retired or separated participants entitled to future benefits	2020-07-01	2
Total of all active and inactive participants	2020-07-01	113
Number of employers contributing to the scheme	2020-07-01	0

Form 5500 Responses for BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN

2021: BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: BOYLE SHAUGHNESSY LAW WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	First time form 5500 has been submitted	Yes
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

4932600

Policy instance

Insurance contract or identification number	4932600
Number of Individuals Covered	189
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $40,865
Total amount of fees paid to insurance company	USD $7,520
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,426,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $26,441
Amount paid for insurance broker fees	7520
Additional information about fees paid to insurance broker	OTHER COMMISSION
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50012035

Policy instance

Insurance contract or identification number	50012035
Number of Individuals Covered	87
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $18,800
Total amount of fees paid to insurance company	USD $1,587
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM,PAID FAMILY MEDICAL LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $84,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,800
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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

Policy contract number

4932600

Policy instance

Insurance contract or identification number	4932600
Number of Individuals Covered	209
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $42,227
Total amount of fees paid to insurance company	USD $4,883
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $42,227
Amount paid for insurance broker fees	4883
Additional information about fees paid to insurance broker	OTHER COMMISSION
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50012035

Policy instance

Insurance contract or identification number	50012035
Number of Individuals Covered	156
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $15,555
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM,PAID FAMILY MEDICAL LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $66,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,555
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	BOYLE SHAUGHNESSY LAW PC
Employer identification number (EIN):	043254479
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers