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BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 401k Plan overview

Plan NameBY APPOINTMENT ONLY HEALTH & WELFARE PLAN
Plan identification number 501

BY APPOINTMENT ONLY HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BY APPOINTMENT ONLY has sponsored the creation of one or more 401k plans.

Company Name:BY APPOINTMENT ONLY
Employer identification number (EIN):043462585
NAIC Classification:561420

Additional information about BY APPOINTMENT ONLY

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 1996-03-11
Company Identification Number: 19961093533

More information about BY APPOINTMENT ONLY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BY APPOINTMENT ONLY HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-02-01LINDA METZGER2023-08-03
5012021-02-01LINDA METZGER2022-08-22
5012020-02-01LINDA METZGER2021-09-02
5012019-02-01
5012018-02-01
5012017-02-01LINDA METZGER
5012016-02-01LINDA METZGER
5012015-02-01LINDA METZGER
5012014-02-01LINDA METZGER
5012013-02-01LINDA METZGER
5012012-02-01LINDA METZGER
5012011-02-01LINDA METZGER
5012010-02-01LINDA METZGER
5012009-02-01LINDA METZGER

Plan Statistics for BY APPOINTMENT ONLY HEALTH & WELFARE PLAN

401k plan membership statisitcs for BY APPOINTMENT ONLY HEALTH & WELFARE PLAN

Measure Date Value
2022: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01151
Total number of active participants reported on line 7a of the Form 55002022-02-01145
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01145
Number of employers contributing to the scheme2022-02-010
2021: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01158
Total number of active participants reported on line 7a of the Form 55002021-02-01149
Number of retired or separated participants receiving benefits2021-02-012
Number of other retired or separated participants entitled to future benefits2021-02-0160
Total of all active and inactive participants2021-02-01211
Number of employers contributing to the scheme2021-02-010
2020: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01174
Total number of active participants reported on line 7a of the Form 55002020-02-01157
Number of retired or separated participants receiving benefits2020-02-011
Number of other retired or separated participants entitled to future benefits2020-02-0115
Total of all active and inactive participants2020-02-01173
Number of employers contributing to the scheme2020-02-010
2019: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01172
Total number of active participants reported on line 7a of the Form 55002019-02-01174
Number of retired or separated participants receiving benefits2019-02-013
Number of other retired or separated participants entitled to future benefits2019-02-0110
Total of all active and inactive participants2019-02-01187
2018: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01201
Total number of active participants reported on line 7a of the Form 55002018-02-01156
Number of retired or separated participants receiving benefits2018-02-013
Number of other retired or separated participants entitled to future benefits2018-02-0113
Total of all active and inactive participants2018-02-01172
2017: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-01187
Total number of active participants reported on line 7a of the Form 55002017-02-01179
Number of retired or separated participants receiving benefits2017-02-011
Number of other retired or separated participants entitled to future benefits2017-02-0121
Total of all active and inactive participants2017-02-01201
Total participants2017-02-01201
2016: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01223
Total number of active participants reported on line 7a of the Form 55002016-02-01180
Number of retired or separated participants receiving benefits2016-02-013
Number of other retired or separated participants entitled to future benefits2016-02-014
Total of all active and inactive participants2016-02-01187
Total participants2016-02-01187
2015: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01234
Total number of active participants reported on line 7a of the Form 55002015-02-01199
Number of retired or separated participants receiving benefits2015-02-017
Number of other retired or separated participants entitled to future benefits2015-02-0117
Total of all active and inactive participants2015-02-01223
Total participants2015-02-01223
2014: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01239
Total number of active participants reported on line 7a of the Form 55002014-02-01229
Number of retired or separated participants receiving benefits2014-02-015
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01234
Total participants2014-02-01234
2013: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01158
Total number of active participants reported on line 7a of the Form 55002013-02-01225
Number of retired or separated participants receiving benefits2013-02-017
Number of other retired or separated participants entitled to future benefits2013-02-017
Total of all active and inactive participants2013-02-01239
Total participants2013-02-01239
2012: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-01192
Total number of active participants reported on line 7a of the Form 55002012-02-01150
Number of retired or separated participants receiving benefits2012-02-011
Number of other retired or separated participants entitled to future benefits2012-02-017
Total of all active and inactive participants2012-02-01158
Total participants2012-02-01158
2011: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-01207
Total number of active participants reported on line 7a of the Form 55002011-02-01172
Number of retired or separated participants receiving benefits2011-02-012
Number of other retired or separated participants entitled to future benefits2011-02-0118
Total of all active and inactive participants2011-02-01192
Total participants2011-02-01192
2010: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-01196
Total number of active participants reported on line 7a of the Form 55002010-02-01178
Number of retired or separated participants receiving benefits2010-02-017
Number of other retired or separated participants entitled to future benefits2010-02-0122
Total of all active and inactive participants2010-02-01207
Total participants2010-02-01207
2009: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-01199
Total number of active participants reported on line 7a of the Form 55002009-02-01186
Number of retired or separated participants receiving benefits2009-02-016
Number of other retired or separated participants entitled to future benefits2009-02-014
Total of all active and inactive participants2009-02-01196
Total participants2009-02-01196

Form 5500 Responses for BY APPOINTMENT ONLY HEALTH & WELFARE PLAN

2022: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan funding arrangement – General assets of the sponsorYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – General assets of the sponsorYes
2021: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan funding arrangement – General assets of the sponsorYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – General assets of the sponsorYes
2020: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan funding arrangement – General assets of the sponsorYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – General assets of the sponsorYes
2019: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes
2012: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan benefit arrangement – InsuranceYes
2011: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan benefit arrangement – InsuranceYes
2010: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan benefit arrangement – InsuranceYes
2009: BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPROAFBY
Policy instance 5
Insurance contract or identification numberGUPROAFBY
Number of Individuals Covered145
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $7,838
Total amount of fees paid to insurance companyUSD $4,918
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM,ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $62,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,838
Amount paid for insurance broker fees4918
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12256034
Policy instance 4
Insurance contract or identification number12256034
Number of Individuals Covered65
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $846
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $846
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number3985
Policy instance 3
Insurance contract or identification number3985
Number of Individuals Covered194
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $4,335
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,335
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number45785000
Policy instance 2
Insurance contract or identification number45785000
Number of Individuals Covered54
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $9,651
Total amount of fees paid to insurance companyUSD $8,612
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $470,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,651
Amount paid for insurance broker fees8612
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 1
Insurance contract or identification number79372000
Number of Individuals Covered104
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $16,791
Total amount of fees paid to insurance companyUSD $15,589
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $972,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,791
Amount paid for insurance broker fees15589
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 1
Insurance contract or identification number79372000
Number of Individuals Covered112
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $24,354
Total amount of fees paid to insurance companyUSD $12,391
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,016,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,354
Amount paid for insurance broker fees12391
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number45785000
Policy instance 2
Insurance contract or identification number45785000
Number of Individuals Covered68
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $11,538
Total amount of fees paid to insurance companyUSD $6,787
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $568,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,538
Amount paid for insurance broker fees6787
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number3985
Policy instance 3
Insurance contract or identification number3985
Number of Individuals Covered216
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $2,726
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $109,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,726
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12256034
Policy instance 4
Insurance contract or identification number12256034
Number of Individuals Covered78
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $876
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $876
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPROAFBY
Policy instance 5
Insurance contract or identification numberGUPROAFBY
Number of Individuals Covered149
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $8,875
Total amount of fees paid to insurance companyUSD $4,722
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM,ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $70,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,875
Amount paid for insurance broker fees4722
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 1
Insurance contract or identification number79372000
Number of Individuals Covered120
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $23,758
Total amount of fees paid to insurance companyUSD $12,565
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,029,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,758
Amount paid for insurance broker fees12565
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number45785000
Policy instance 2
Insurance contract or identification number45785000
Number of Individuals Covered55
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $12,196
Total amount of fees paid to insurance companyUSD $6,539
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $556,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,196
Amount paid for insurance broker fees6539
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number3985
Policy instance 3
Insurance contract or identification number3985
Number of Individuals Covered208
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $4,868
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,868
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12256034
Policy instance 4
Insurance contract or identification number12256034
Number of Individuals Covered78
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $893
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $893
Amount paid for insurance broker fees0
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUGOAFBY
Policy instance 5
Insurance contract or identification numberGLUGOAFBY
Number of Individuals Covered157
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $9,418
Total amount of fees paid to insurance companyUSD $5,714
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $76,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,418
Amount paid for insurance broker fees5714
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered226
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $4,641
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $118,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,641
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12256034
Policy instance 2
Insurance contract or identification number12256034
Number of Individuals Covered82
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $114
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $114
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFBY
Policy instance 3
Insurance contract or identification numberG000AFBY
Number of Individuals Covered174
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $10,226
Total amount of fees paid to insurance companyUSD $5,881
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $82,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,226
Amount paid for insurance broker fees5881
Insurance broker organization code?3
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number120109083542
Policy instance 4
Insurance contract or identification number120109083542
Number of Individuals Covered72
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $14,940
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $588,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,940
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number120109083542
Policy instance 5
Insurance contract or identification number120109083542
Number of Individuals Covered134
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $32,592
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,053,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,592
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 5
Insurance contract or identification number79372000
Number of Individuals Covered160
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $20,296
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $993,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,296
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
Policy contract number45785000/6000
Policy instance 4
Insurance contract or identification number45785000/6000
Number of Individuals Covered72
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $10,254
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $506,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,254
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFBY
Policy instance 3
Insurance contract or identification numberG000AFBY
Number of Individuals Covered179
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $13,579
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $93,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,579
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12256034
Policy instance 2
Insurance contract or identification number12256034
Number of Individuals Covered89
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $958
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $958
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered261
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $4,906
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,906
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 5
Insurance contract or identification number79372000
Number of Individuals Covered181
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $21,442
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,088,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,442
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered288
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $4,828
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $137,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,828
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number12256034
Policy instance 2
Insurance contract or identification number12256034
Number of Individuals Covered102
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $1,036
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,036
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFBY
Policy instance 3
Insurance contract or identification numberG000AFBY
Number of Individuals Covered199
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $12,321
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,321
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45785000/6000
Policy instance 4
Insurance contract or identification number45785000/6000
Number of Individuals Covered92
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $9,797
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $520,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,797
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered321
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $5,076
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,076
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number12256034
Policy instance 2
Insurance contract or identification number12256034
Number of Individuals Covered91
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $977
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $977
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFBY
Policy instance 3
Insurance contract or identification numberG000AFBY
Number of Individuals Covered229
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $8,918
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,918
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45785000/6000
Policy instance 4
Insurance contract or identification number45785000/6000
Number of Individuals Covered92
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $10,432
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $520,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,432
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 5
Insurance contract or identification number79372000
Number of Individuals Covered181
Total amount of commissions paid to insurance brokerUSD $22,980
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,088,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,980
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45785000
Policy instance 4
Insurance contract or identification number45785000
Number of Individuals Covered19
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $4,554
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $189,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,217
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number12256034
Policy instance 2
Insurance contract or identification number12256034
Number of Individuals Covered97
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $919
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $919
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 5
Insurance contract or identification number79372000
Number of Individuals Covered111
Total amount of commissions paid to insurance brokerUSD $26,762
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,087,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,126
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45786000
Policy instance 6
Insurance contract or identification number45786000
Number of Individuals Covered27
Total amount of commissions paid to insurance brokerUSD $5,908
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $252,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,589
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered317
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $5,025
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,025
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFBY
Policy instance 3
Insurance contract or identification numberG000AFBY
Number of Individuals Covered225
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $11,587
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,587
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79372000
Policy instance 6
Insurance contract or identification number79372000
Number of Individuals Covered86
Total amount of commissions paid to insurance brokerUSD $23,059
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $948,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,059
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45785000
Policy instance 5
Insurance contract or identification number45785000
Number of Individuals Covered14
Total amount of commissions paid to insurance brokerUSD $4,934
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $196,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,934
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered258
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $4,514
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,514
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AFBY
Policy instance 4
Insurance contract or identification numberG000AFBY
Number of Individuals Covered150
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $10,400
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,400
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number12256034
Policy instance 3
Insurance contract or identification number12256034
Number of Individuals Covered74
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $843
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $843
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45786000
Policy instance 2
Insurance contract or identification number45786000
Number of Individuals Covered17
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $4,304
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $188,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,304
Insurance broker organization code?3
Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4955493
Policy instance 2
Insurance contract or identification number4955493
Number of Individuals Covered127
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $33,456
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number12256034
Policy instance 3
Insurance contract or identification number12256034
Number of Individuals Covered85
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $925
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,926
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 numberG000AFBY
Policy instance 4
Insurance contract or identification numberG000AFBY
Number of Individuals Covered172
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $13,253
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered265
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $4,723
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $121,773
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 numberG000AFBY
Policy instance 4
Insurance contract or identification numberG000AFBY
Number of Individuals Covered178
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,305
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,305
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number12256034
Policy instance 3
Insurance contract or identification number12256034
Number of Individuals Covered98
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $1,046
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,046
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4955493
Policy instance 2
Insurance contract or identification number4955493
Number of Individuals Covered146
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $43,529
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,425,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,390
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number003985
Policy instance 1
Insurance contract or identification number003985
Number of Individuals Covered298
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $4,997
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,997
Insurance broker organization code?3
Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY

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