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401k Plan overview

Plan NameWEST BAY RESIDENTIAL SERVICES, INC. WELFARE WRAP PLAN
Plan identification number 510

WEST BAY RESIDENTIAL SERVICES, INC. WELFARE WRAP PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    WEST BAY RESIDENTIAL SERVICES, INC. has sponsored the creation of one or more 401k plans.

    Company Name:WEST BAY RESIDENTIAL SERVICES, INC.
    Employer identification number (EIN):050395035
    NAIC Classification:531390
    NAIC Description:Other Activities Related to Real Estate

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan WEST BAY RESIDENTIAL SERVICES, INC. WELFARE WRAP PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5102020-03-01BRENDA HILL2021-07-29
    5102019-03-01BRENDA HILL2020-07-13
    5102018-03-01
    5102017-03-01
    5102016-03-01
    5102015-03-01
    5102014-03-01
    5102013-03-01
    5102012-03-01
    5102011-03-01
    5102010-03-01
    5102009-03-01
    5102008-03-01
    5102007-03-01
    5102006-03-01
    5102005-03-01
    5102004-03-01
    5102003-03-01
    5102002-03-01
    5102001-03-01
    5102000-03-01
    5101999-03-01

    Plan Statistics for WEST BAY RESIDENTIAL SERVICES, INC. WELFARE WRAP PLAN

    401k plan membership statisitcs for WEST BAY RESIDENTIAL SERVICES, INC. WELFARE WRAP PLAN

    Measure Date Value
    2020
    Total participants, beginning-of-year2020-03-01208
    Total number of active participants reported on line 7a of the Form 55002020-03-01208
    Number of retired or separated participants receiving benefits2020-03-010
    Number of other retired or separated participants entitled to future benefits2020-03-010
    Total of all active and inactive participants2020-03-01208
    2019
    Total participants, beginning-of-year2019-03-01196
    Total number of active participants reported on line 7a of the Form 55002019-03-01208
    Number of retired or separated participants receiving benefits2019-03-010
    Number of other retired or separated participants entitled to future benefits2019-03-010
    Total of all active and inactive participants2019-03-01208
    2018
    Total participants, beginning-of-year2018-03-01190
    Total number of active participants reported on line 7a of the Form 55002018-03-01196
    Number of retired or separated participants receiving benefits2018-03-010
    Number of other retired or separated participants entitled to future benefits2018-03-010
    Total of all active and inactive participants2018-03-01196
    2017
    Total participants, beginning-of-year2017-03-01180
    Total number of active participants reported on line 7a of the Form 55002017-03-01188
    Number of retired or separated participants receiving benefits2017-03-012
    Number of other retired or separated participants entitled to future benefits2017-03-010
    Total of all active and inactive participants2017-03-01190
    2016
    Total participants, beginning-of-year2016-03-01176
    Total number of active participants reported on line 7a of the Form 55002016-03-01180
    Number of retired or separated participants receiving benefits2016-03-010
    Number of other retired or separated participants entitled to future benefits2016-03-010
    Total of all active and inactive participants2016-03-01180
    2015
    Total participants, beginning-of-year2015-03-01169
    Total number of active participants reported on line 7a of the Form 55002015-03-01176
    Number of retired or separated participants receiving benefits2015-03-010
    Number of other retired or separated participants entitled to future benefits2015-03-010
    Total of all active and inactive participants2015-03-01176
    2014
    Total participants, beginning-of-year2014-03-01165
    Total number of active participants reported on line 7a of the Form 55002014-03-01169
    Number of retired or separated participants receiving benefits2014-03-010
    Number of other retired or separated participants entitled to future benefits2014-03-010
    Total of all active and inactive participants2014-03-01169
    2013
    Total participants, beginning-of-year2013-03-01171
    Total number of active participants reported on line 7a of the Form 55002013-03-01165
    Number of retired or separated participants receiving benefits2013-03-010
    Number of other retired or separated participants entitled to future benefits2013-03-010
    Total of all active and inactive participants2013-03-01165
    2012
    Total participants, beginning-of-year2012-03-01184
    Total number of active participants reported on line 7a of the Form 55002012-03-01171
    Number of retired or separated participants receiving benefits2012-03-010
    Number of other retired or separated participants entitled to future benefits2012-03-010
    Total of all active and inactive participants2012-03-01171
    2011
    Total participants, beginning-of-year2011-03-01193
    Total number of active participants reported on line 7a of the Form 55002011-03-01184
    Number of retired or separated participants receiving benefits2011-03-010
    Number of other retired or separated participants entitled to future benefits2011-03-010
    Total of all active and inactive participants2011-03-01184
    2010
    Total participants, beginning-of-year2010-03-01191
    Total number of active participants reported on line 7a of the Form 55002010-03-01193
    Number of retired or separated participants receiving benefits2010-03-010
    Number of other retired or separated participants entitled to future benefits2010-03-010
    Total of all active and inactive participants2010-03-01193
    2009
    Total participants, beginning-of-year2009-03-01194
    Total number of active participants reported on line 7a of the Form 55002009-03-01191
    Number of retired or separated participants receiving benefits2009-03-010
    Number of other retired or separated participants entitled to future benefits2009-03-010
    Total of all active and inactive participants2009-03-01191
    2008
    Total participants, beginning-of-year2008-03-01212
    Total number of active participants reported on line 7a of the Form 55002008-03-01194
    Number of retired or separated participants receiving benefits2008-03-010
    Number of other retired or separated participants entitled to future benefits2008-03-010
    Total of all active and inactive participants2008-03-01194
    2007
    Total participants, beginning-of-year2007-03-01202
    Total number of active participants reported on line 7a of the Form 55002007-03-01212
    Number of retired or separated participants receiving benefits2007-03-010
    Number of other retired or separated participants entitled to future benefits2007-03-010
    Total of all active and inactive participants2007-03-01212
    2006
    Total participants, beginning-of-year2006-03-01207
    Total number of active participants reported on line 7a of the Form 55002006-03-01202
    Number of retired or separated participants receiving benefits2006-03-010
    Number of other retired or separated participants entitled to future benefits2006-03-010
    Total of all active and inactive participants2006-03-01202
    2005
    Total participants, beginning-of-year2005-03-01196
    Total number of active participants reported on line 7a of the Form 55002005-03-01207
    Number of retired or separated participants receiving benefits2005-03-010
    Number of other retired or separated participants entitled to future benefits2005-03-010
    Total of all active and inactive participants2005-03-01207
    2004
    Total participants, beginning-of-year2004-03-01163
    Total number of active participants reported on line 7a of the Form 55002004-03-01196
    Number of retired or separated participants receiving benefits2004-03-010
    Number of other retired or separated participants entitled to future benefits2004-03-010
    Total of all active and inactive participants2004-03-01196
    2003
    Total participants, beginning-of-year2003-03-01193
    Total number of active participants reported on line 7a of the Form 55002003-03-01163
    Number of retired or separated participants receiving benefits2003-03-010
    Number of other retired or separated participants entitled to future benefits2003-03-010
    Total of all active and inactive participants2003-03-01163
    2002
    Total participants, beginning-of-year2002-03-01214
    Total number of active participants reported on line 7a of the Form 55002002-03-01193
    Number of retired or separated participants receiving benefits2002-03-010
    Number of other retired or separated participants entitled to future benefits2002-03-010
    Total of all active and inactive participants2002-03-01193
    2001
    Total participants, beginning-of-year2001-03-01191
    Total number of active participants reported on line 7a of the Form 55002001-03-01214
    Number of retired or separated participants receiving benefits2001-03-010
    Number of other retired or separated participants entitled to future benefits2001-03-010
    Total of all active and inactive participants2001-03-01214
    2000
    Total participants, beginning-of-year2000-03-01195
    Total number of active participants reported on line 7a of the Form 55002000-03-01191
    Number of retired or separated participants receiving benefits2000-03-010
    Number of other retired or separated participants entitled to future benefits2000-03-010
    Total of all active and inactive participants2000-03-01191
    1999
    Total participants, beginning-of-year1999-03-01100
    Total number of active participants reported on line 7a of the Form 55001999-03-01195
    Number of retired or separated participants receiving benefits1999-03-010
    Number of other retired or separated participants entitled to future benefits1999-03-010
    Total of all active and inactive participants1999-03-01195

    Form 5500 Responses

    2020
    2020-03-01Type of plan entitySingle employer plan
    2020-03-01Submission has been amendedNo
    2020-03-01This submission is the final filingNo
    2020-03-01This return/report is a short plan year return/report (less than 12 months)No
    2020-03-01Plan is a collectively bargained planNo
    2020-03-01Plan funding arrangement – InsuranceYes
    2020-03-01Plan funding arrangement – General assets of the sponsorYes
    2020-03-01Plan benefit arrangement – InsuranceYes
    2020-03-01Plan benefit arrangement – General assets of the sponsorYes
    2019
    2019-03-01Type of plan entitySingle employer plan
    2019-03-01Submission has been amendedNo
    2019-03-01This submission is the final filingNo
    2019-03-01This return/report is a short plan year return/report (less than 12 months)No
    2019-03-01Plan is a collectively bargained planNo
    2019-03-01Plan funding arrangement – InsuranceYes
    2019-03-01Plan funding arrangement – General assets of the sponsorYes
    2019-03-01Plan benefit arrangement – InsuranceYes
    2019-03-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-03-01Type of plan entitySingle employer plan
    2018-03-01Submission has been amendedNo
    2018-03-01This submission is the final filingNo
    2018-03-01This return/report is a short plan year return/report (less than 12 months)No
    2018-03-01Plan is a collectively bargained planNo
    2018-03-01Plan funding arrangement – InsuranceYes
    2018-03-01Plan funding arrangement – General assets of the sponsorYes
    2018-03-01Plan benefit arrangement – InsuranceYes
    2018-03-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-03-01Type of plan entitySingle employer plan
    2017-03-01Submission has been amendedNo
    2017-03-01This submission is the final filingNo
    2017-03-01This return/report is a short plan year return/report (less than 12 months)No
    2017-03-01Plan is a collectively bargained planNo
    2017-03-01Plan funding arrangement – InsuranceYes
    2017-03-01Plan funding arrangement – General assets of the sponsorYes
    2017-03-01Plan benefit arrangement – InsuranceYes
    2017-03-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-03-01Type of plan entitySingle employer plan
    2016-03-01Submission has been amendedNo
    2016-03-01This submission is the final filingNo
    2016-03-01This return/report is a short plan year return/report (less than 12 months)No
    2016-03-01Plan is a collectively bargained planNo
    2016-03-01Plan funding arrangement – InsuranceYes
    2016-03-01Plan funding arrangement – General assets of the sponsorYes
    2016-03-01Plan benefit arrangement – InsuranceYes
    2016-03-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-03-01Type of plan entitySingle employer plan
    2015-03-01Submission has been amendedNo
    2015-03-01This submission is the final filingNo
    2015-03-01This return/report is a short plan year return/report (less than 12 months)No
    2015-03-01Plan is a collectively bargained planNo
    2015-03-01Plan funding arrangement – InsuranceYes
    2015-03-01Plan benefit arrangement – InsuranceYes
    2014
    2014-03-01Type of plan entitySingle employer plan
    2014-03-01Submission has been amendedNo
    2014-03-01This submission is the final filingNo
    2014-03-01This return/report is a short plan year return/report (less than 12 months)No
    2014-03-01Plan is a collectively bargained planNo
    2014-03-01Plan funding arrangement – InsuranceYes
    2014-03-01Plan benefit arrangement – InsuranceYes
    2013
    2013-03-01Type of plan entitySingle employer plan
    2013-03-01Submission has been amendedNo
    2013-03-01This submission is the final filingNo
    2013-03-01This return/report is a short plan year return/report (less than 12 months)No
    2013-03-01Plan is a collectively bargained planNo
    2013-03-01Plan funding arrangement – InsuranceYes
    2013-03-01Plan benefit arrangement – InsuranceYes
    2012
    2012-03-01Type of plan entitySingle employer plan
    2012-03-01Submission has been amendedNo
    2012-03-01This submission is the final filingNo
    2012-03-01This return/report is a short plan year return/report (less than 12 months)No
    2012-03-01Plan is a collectively bargained planNo
    2012-03-01Plan funding arrangement – InsuranceYes
    2012-03-01Plan benefit arrangement – InsuranceYes
    2011
    2011-03-01Type of plan entitySingle employer plan
    2011-03-01Submission has been amendedNo
    2011-03-01This submission is the final filingNo
    2011-03-01This return/report is a short plan year return/report (less than 12 months)No
    2011-03-01Plan is a collectively bargained planNo
    2011-03-01Plan funding arrangement – InsuranceYes
    2011-03-01Plan benefit arrangement – InsuranceYes
    2010
    2010-03-01Type of plan entitySingle employer plan
    2010-03-01Submission has been amendedNo
    2010-03-01This submission is the final filingNo
    2010-03-01This return/report is a short plan year return/report (less than 12 months)No
    2010-03-01Plan is a collectively bargained planNo
    2010-03-01Plan funding arrangement – InsuranceYes
    2010-03-01Plan benefit arrangement – InsuranceYes
    2009
    2009-03-01Type of plan entitySingle employer plan
    2009-03-01Submission has been amendedNo
    2009-03-01This submission is the final filingNo
    2009-03-01This return/report is a short plan year return/report (less than 12 months)No
    2009-03-01Plan is a collectively bargained planNo
    2009-03-01Plan funding arrangement – InsuranceYes
    2009-03-01Plan benefit arrangement – InsuranceYes
    2008
    2008-03-01Type of plan entitySingle employer plan
    2008-03-01Submission has been amendedNo
    2008-03-01This submission is the final filingNo
    2008-03-01This return/report is a short plan year return/report (less than 12 months)No
    2008-03-01Plan is a collectively bargained planNo
    2008-03-01Plan funding arrangement – InsuranceYes
    2008-03-01Plan benefit arrangement – InsuranceYes
    2007
    2007-03-01Type of plan entitySingle employer plan
    2007-03-01Submission has been amendedNo
    2007-03-01This submission is the final filingNo
    2007-03-01This return/report is a short plan year return/report (less than 12 months)No
    2007-03-01Plan is a collectively bargained planNo
    2007-03-01Plan funding arrangement – InsuranceYes
    2007-03-01Plan benefit arrangement – InsuranceYes
    2006
    2006-03-01Type of plan entitySingle employer plan
    2006-03-01Submission has been amendedNo
    2006-03-01This submission is the final filingNo
    2006-03-01This return/report is a short plan year return/report (less than 12 months)No
    2006-03-01Plan is a collectively bargained planNo
    2006-03-01Plan funding arrangement – InsuranceYes
    2006-03-01Plan benefit arrangement – InsuranceYes
    2005
    2005-03-01Type of plan entitySingle employer plan
    2005-03-01Submission has been amendedNo
    2005-03-01This submission is the final filingNo
    2005-03-01This return/report is a short plan year return/report (less than 12 months)No
    2005-03-01Plan is a collectively bargained planNo
    2005-03-01Plan funding arrangement – InsuranceYes
    2005-03-01Plan benefit arrangement – InsuranceYes
    2004
    2004-03-01Type of plan entitySingle employer plan
    2004-03-01Submission has been amendedNo
    2004-03-01This submission is the final filingNo
    2004-03-01This return/report is a short plan year return/report (less than 12 months)No
    2004-03-01Plan is a collectively bargained planNo
    2004-03-01Plan funding arrangement – InsuranceYes
    2004-03-01Plan benefit arrangement – InsuranceYes
    2003
    2003-03-01Type of plan entitySingle employer plan
    2003-03-01Submission has been amendedNo
    2003-03-01This submission is the final filingNo
    2003-03-01This return/report is a short plan year return/report (less than 12 months)No
    2003-03-01Plan is a collectively bargained planNo
    2003-03-01Plan funding arrangement – InsuranceYes
    2003-03-01Plan benefit arrangement – InsuranceYes
    2002
    2002-03-01Type of plan entitySingle employer plan
    2002-03-01Submission has been amendedNo
    2002-03-01This submission is the final filingNo
    2002-03-01This return/report is a short plan year return/report (less than 12 months)No
    2002-03-01Plan is a collectively bargained planNo
    2002-03-01Plan funding arrangement – InsuranceYes
    2002-03-01Plan benefit arrangement – InsuranceYes
    2001
    2001-03-01Type of plan entitySingle employer plan
    2001-03-01Submission has been amendedNo
    2001-03-01This submission is the final filingNo
    2001-03-01This return/report is a short plan year return/report (less than 12 months)No
    2001-03-01Plan is a collectively bargained planNo
    2001-03-01Plan funding arrangement – InsuranceYes
    2001-03-01Plan benefit arrangement – InsuranceYes
    2000
    2000-03-01Type of plan entitySingle employer plan
    2000-03-01Submission has been amendedNo
    2000-03-01This submission is the final filingNo
    2000-03-01This return/report is a short plan year return/report (less than 12 months)No
    2000-03-01Plan is a collectively bargained planNo
    2000-03-01Plan funding arrangement – InsuranceYes
    2000-03-01Plan benefit arrangement – InsuranceYes
    1999
    1999-03-01Type of plan entitySingle employer plan
    1999-03-01First time form 5500 has been submittedYes
    1999-03-01Submission has been amendedNo
    1999-03-01This submission is the final filingNo
    1999-03-01This return/report is a short plan year return/report (less than 12 months)No
    1999-03-01Plan is a collectively bargained planNo
    1999-03-01Plan funding arrangement – InsuranceYes
    1999-03-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL156723
    Policy instance 4
    Insurance contract or identification numberGL156723
    Number of Individuals Covered285
    Insurance policy start date2019-11-01
    Insurance policy end date2020-10-31
    Total amount of commissions paid to insurance brokerUSD $2,387
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    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 CarrierUSD $16,784
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,549
    Insurance broker organization code?3
    DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
    Policy contract number6950-137
    Policy instance 3
    Insurance contract or identification number6950-137
    Number of Individuals Covered2
    Insurance policy start date2020-10-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $1
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1
    Insurance broker organization code?3
    DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
    Policy contract number6950-132
    Policy instance 2
    Insurance contract or identification number6950-132
    Number of Individuals Covered458
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $1,217
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,217
    Insurance broker organization code?3
    BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
    Policy contract number001002784
    Policy instance 1
    Insurance contract or identification number001002784
    Number of Individuals Covered438
    Insurance policy start date2020-03-01
    Insurance policy end date2021-02-28
    Total amount of commissions paid to insurance brokerUSD $2,205
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $2,471,383
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,205
    Insurance broker organization code?3
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL156723
    Policy instance 4
    Insurance contract or identification numberGL156723
    Number of Individuals Covered256
    Insurance policy start date2018-11-01
    Insurance policy end date2019-10-31
    Total amount of commissions paid to insurance brokerUSD $1,984
    Total amount of fees paid to insurance companyUSD $191
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    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 CarrierUSD $13,289
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,320
    Insurance broker organization code?3
    Amount paid for insurance broker fees191
    Additional information about fees paid to insurance brokerADMINISTRATIVE & OTHER FEES
    DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
    Policy contract number6950-132
    Policy instance 3
    Insurance contract or identification number6950-132
    Number of Individuals Covered448
    Insurance policy start date2019-10-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $627
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $627
    Insurance broker organization code?3
    DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
    Policy contract number61201
    Policy instance 2
    Insurance contract or identification number61201
    Number of Individuals Covered450
    Insurance policy start date2019-03-01
    Insurance policy end date2019-09-30
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $115,775
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
    Policy contract number001002784
    Policy instance 1
    Insurance contract or identification number001002784
    Number of Individuals Covered435
    Insurance policy start date2019-03-01
    Insurance policy end date2020-02-29
    Total amount of commissions paid to insurance brokerUSD $21,150
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $2,361,931
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $21,150
    Insurance broker organization code?3
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL156723
    Policy instance 4
    Insurance contract or identification numberGL156723
    Number of Individuals Covered264
    Insurance policy start date2017-11-01
    Insurance policy end date2018-10-31
    Total amount of commissions paid to insurance brokerUSD $2,096
    Total amount of fees paid to insurance companyUSD $436
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    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 CarrierUSD $13,910
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,401
    Insurance broker organization code?3
    Amount paid for insurance broker fees436
    Additional information about fees paid to insurance brokerADMINISTRATIVE & OTHER FEES
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number38587000
    Policy instance 3
    Insurance contract or identification number38587000
    Number of Individuals Covered351
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,731,019
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
    Policy contract number61201
    Policy instance 2
    Insurance contract or identification number61201
    Number of Individuals Covered436
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $193,370
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number377725000
    Policy instance 1
    Insurance contract or identification number377725000
    Number of Individuals Covered62
    Insurance policy start date2018-03-01
    Insurance policy end date2019-02-28
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $380,347
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
    Policy contract numberGL156723
    Policy instance 4
    Insurance contract or identification numberGL156723
    Number of Individuals Covered236
    Insurance policy start date2016-11-01
    Insurance policy end date2017-10-31
    Total amount of commissions paid to insurance brokerUSD $1,814
    Total amount of fees paid to insurance companyUSD $75
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    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 CarrierUSD $11,866
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,221
    Insurance broker organization code?3
    Amount paid for insurance broker fees75
    Additional information about fees paid to insurance brokerADMINISTRATIVE & OTHER FEES
    Insurance broker nameEMERSON REID & COMPANY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number38587000
    Policy instance 3
    Insurance contract or identification number38587000
    Number of Individuals Covered358
    Insurance policy start date2016-04-01
    Insurance policy end date2017-03-31
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $1,418,803
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
    Policy contract number61201
    Policy instance 2
    Insurance contract or identification number61201
    Number of Individuals Covered411
    Insurance policy start date2017-03-01
    Insurance policy end date2018-02-28
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $178,008
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number377725000
    Policy instance 1
    Insurance contract or identification number377725000
    Number of Individuals Covered53
    Insurance policy start date2016-04-01
    Insurance policy end date2017-03-31
    Are there contracts with allocated funds for individual policies?0
    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 planNo
    Contracts With Unallocated Funds Deposit Administration0
    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 BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 CarrierUSD $162,849
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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