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MARTIGNETTI COMPANIES 401k Plan overview

Plan NameMARTIGNETTI COMPANIES
Plan identification number 501

MARTIGNETTI COMPANIES 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

MARTIGNETTI COMPANIES has sponsored the creation of one or more 401k plans.

Company Name:MARTIGNETTI COMPANIES
Employer identification number (EIN):464033150
NAIC Classification:424800

Additional information about MARTIGNETTI COMPANIES

Jurisdiction of Incorporation: California Department of State
Incorporation Date: 2010-09-13
Company Identification Number: C3330992
Legal Registered Office Address: 3852 Harris St

La Mesa
United States of America (USA)
91941

More information about MARTIGNETTI COMPANIES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARTIGNETTI COMPANIES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01DEAN CRANDALL2023-12-28
5012021-04-01DEAN CRANDALL2022-10-18
5012020-04-01DEAN CRANDALL2021-10-12
5012019-04-01DEAN CRANDALL2020-10-15
5012018-04-01DEAN CRANDALL2019-10-16
5012017-04-01
5012017-04-01
5012016-04-01THERESA OCONNOR THERESA OCONNOR2017-10-16
5012015-04-01THERESA OCONNOR THERESA OCONNOR2016-10-17
5012013-04-01DEAN CRANDALL2019-12-10

Plan Statistics for MARTIGNETTI COMPANIES

401k plan membership statisitcs for MARTIGNETTI COMPANIES

Measure Date Value
2022: MARTIGNETTI COMPANIES 2022 401k membership
Total participants, beginning-of-year2022-04-01711
Total number of active participants reported on line 7a of the Form 55002022-04-01702
Number of retired or separated participants receiving benefits2022-04-015
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01707
Number of employers contributing to the scheme2022-04-010
2021: MARTIGNETTI COMPANIES 2021 401k membership
Total participants, beginning-of-year2021-04-01705
Total number of active participants reported on line 7a of the Form 55002021-04-01695
Number of retired or separated participants receiving benefits2021-04-0116
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01711
Number of employers contributing to the scheme2021-04-010
2020: MARTIGNETTI COMPANIES 2020 401k membership
Total participants, beginning-of-year2020-04-01685
Total number of active participants reported on line 7a of the Form 55002020-04-01705
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01705
Number of employers contributing to the scheme2020-04-010
2019: MARTIGNETTI COMPANIES 2019 401k membership
Total participants, beginning-of-year2019-04-01696
Total number of active participants reported on line 7a of the Form 55002019-04-01685
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01685
Number of employers contributing to the scheme2019-04-010
2018: MARTIGNETTI COMPANIES 2018 401k membership
Total participants, beginning-of-year2018-04-01698
Total number of active participants reported on line 7a of the Form 55002018-04-01690
Number of retired or separated participants receiving benefits2018-04-016
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01696
Number of employers contributing to the scheme2018-04-010
2017: MARTIGNETTI COMPANIES 2017 401k membership
Total participants, beginning-of-year2017-04-01679
Total number of active participants reported on line 7a of the Form 55002017-04-01698
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01698
2016: MARTIGNETTI COMPANIES 2016 401k membership
Total participants, beginning-of-year2016-04-01679
Total number of active participants reported on line 7a of the Form 55002016-04-01698
Total of all active and inactive participants2016-04-01698
2015: MARTIGNETTI COMPANIES 2015 401k membership
Total participants, beginning-of-year2015-04-01671
Total number of active participants reported on line 7a of the Form 55002015-04-01679
Total of all active and inactive participants2015-04-01679
2013: MARTIGNETTI COMPANIES 2013 401k membership
Total participants, beginning-of-year2013-04-01639
Total number of active participants reported on line 7a of the Form 55002013-04-01653
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-01653
Number of employers contributing to the scheme2013-04-010

Form 5500 Responses for MARTIGNETTI COMPANIES

2022: MARTIGNETTI COMPANIES 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: MARTIGNETTI COMPANIES 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: MARTIGNETTI COMPANIES 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: MARTIGNETTI COMPANIES 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: MARTIGNETTI COMPANIES 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: MARTIGNETTI COMPANIES 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedYes
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: MARTIGNETTI COMPANIES 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: MARTIGNETTI COMPANIES 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: MARTIGNETTI COMPANIES 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number470346
Policy instance 5
Insurance contract or identification number470346
Number of Individuals Covered702
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $30,706
Total amount of fees paid to insurance companyUSD $10,275
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,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $365,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,457
Amount paid for insurance broker fees9381
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number169467
Policy instance 4
Insurance contract or identification number169467
Number of Individuals Covered83
Insurance policy start date2021-09-15
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,099
Total amount of fees paid to insurance companyUSD $2,355
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,099
Amount paid for insurance broker fees2355
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99071500
Policy instance 3
Insurance contract or identification number99071500
Number of Individuals Covered702
Insurance policy start date2021-04-02
Insurance policy end date2022-04-01
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $79
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $225
Amount paid for insurance broker fees79
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10055951001
Policy instance 2
Insurance contract or identification number10055951001
Number of Individuals Covered995
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $5,848
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,848
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4957125
Policy instance 1
Insurance contract or identification number4957125
Number of Individuals Covered1247
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $13,494
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $13,494
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number470346
Policy instance 5
Insurance contract or identification number470346
Number of Individuals Covered695
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $29,934
Total amount of fees paid to insurance companyUSD $8,920
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,HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $538,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,997
Amount paid for insurance broker fees8824
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number919129
Policy instance 4
Insurance contract or identification number919129
Number of Individuals Covered86
Insurance policy start date2020-09-15
Insurance policy end date2021-09-14
Total amount of commissions paid to insurance brokerUSD $3,964
Total amount of fees paid to insurance companyUSD $1,409
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $88,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,964
Amount paid for insurance broker fees1409
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4957125
Policy instance 1
Insurance contract or identification number4957125
Number of Individuals Covered1268
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $13,618
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $13,618
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10055951001
Policy instance 2
Insurance contract or identification number10055951001
Number of Individuals Covered1009
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $6,258
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,258
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99071500
Policy instance 3
Insurance contract or identification number99071500
Number of Individuals Covered695
Insurance policy start date2020-04-02
Insurance policy end date2021-04-01
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $79
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $225
Amount paid for insurance broker fees79
Additional information about fees paid to insurance brokerCONTINGENT COMMISSIONS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4957125
Policy instance 1
Insurance contract or identification number4957125
Number of Individuals Covered1274
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $14,105
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $14,105
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10055951001
Policy instance 2
Insurance contract or identification number10055951001
Number of Individuals Covered997
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $5,872
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,872
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99071500
Policy instance 3
Insurance contract or identification number99071500
Number of Individuals Covered705
Insurance policy start date2019-04-02
Insurance policy end date2020-04-01
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $47
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $225
Amount paid for insurance broker fees47
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number919129
Policy instance 4
Insurance contract or identification number919129
Number of Individuals Covered86
Insurance policy start date2019-09-15
Insurance policy end date2020-09-14
Total amount of commissions paid to insurance brokerUSD $4,295
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,295
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number470346
Policy instance 5
Insurance contract or identification number470346
Number of Individuals Covered705
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $34,414
Total amount of fees paid to insurance companyUSD $9,373
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 $795,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,443
Amount paid for insurance broker fees9373
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4957125
Policy instance 1
Insurance contract or identification number4957125
Number of Individuals Covered1297
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $13,683
Total amount of fees paid to insurance companyUSD $281
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,683
Amount paid for insurance broker fees281
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number470346
Policy instance 5
Insurance contract or identification number470346
Number of Individuals Covered685
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $31,341
Total amount of fees paid to insurance companyUSD $9,225
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 $460,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,249
Amount paid for insurance broker fees8805
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION, ADDITIONAL COMPENSATION
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number919129
Policy instance 4
Insurance contract or identification number919129
Number of Individuals Covered93
Insurance policy start date2018-09-15
Insurance policy end date2019-09-14
Total amount of commissions paid to insurance brokerUSD $3,708
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,708
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99071500
Policy instance 3
Insurance contract or identification number99071500
Number of Individuals Covered685
Insurance policy start date2018-04-02
Insurance policy end date2019-04-01
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $33
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $225
Amount paid for insurance broker fees33
Additional information about fees paid to insurance brokerCONTINGENT COMMISSION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10055951001
Policy instance 2
Insurance contract or identification number10055951001
Number of Individuals Covered1045
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $5,900
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,900
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4957125
Policy instance 1
Insurance contract or identification number4957125
Number of Individuals Covered1299
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $13,634
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,634
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number470346
Policy instance 4
Insurance contract or identification number470346
Number of Individuals Covered690
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $27,362
Total amount of fees paid to insurance companyUSD $6,427
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 $397,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,200
Amount paid for insurance broker fees6292
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99071500
Policy instance 3
Insurance contract or identification number99071500
Number of Individuals Covered690
Insurance policy start date2017-04-02
Insurance policy end date2018-04-01
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $225
Amount paid for insurance broker fees0
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10055951001
Policy instance 2
Insurance contract or identification number10055951001
Number of Individuals Covered1053
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $6,002
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,002
Amount paid for insurance broker fees0
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99071500
Policy instance 3
Insurance contract or identification number99071500
Number of Individuals Covered698
Insurance policy start date2016-04-02
Insurance policy end date2017-04-01
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $60
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $225
Amount paid for insurance broker fees60
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameEASTERN BENEFITS GROUP
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number154446
Policy instance 5
Insurance contract or identification number154446
Number of Individuals Covered225
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $55,251
Total amount of fees paid to insurance companyUSD $61,806
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $396,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,805
Amount paid for insurance broker fees61648
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER M. ALLEN
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10055951001
Policy instance 2
Insurance contract or identification number10055951001
Number of Individuals Covered1093
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $6,234
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,234
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameEASTERN BENEFITS GROUP
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4957125
Policy instance 1
Insurance contract or identification number4957125
Number of Individuals Covered1336
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $13,644
Total amount of fees paid to insurance companyUSD $237
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $13,644
Amount paid for insurance broker fees237
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameEASTERN BENEFITS GROUP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number470346
Policy instance 4
Insurance contract or identification number470346
Number of Individuals Covered698
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $32,104
Total amount of fees paid to insurance companyUSD $8,691
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 $492,948
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,707
Amount paid for insurance broker fees8545
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER M. ALLEN
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00486291
Policy instance 1
Insurance contract or identification number00486291
Number of Individuals Covered679
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $24,071
Total amount of fees paid to insurance companyUSD $0
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 $364,004
Commission paid to Insurance BrokerUSD $24,071
Insurance broker organization code?3
Insurance broker nameEASTERN INSURANCE GROUP
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099071500
Policy instance 4
Insurance contract or identification number000099071500
Number of Individuals Covered25
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $225
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Commission paid to Insurance BrokerUSD $225
Insurance broker organization code?3
Insurance broker nameEASTERN INSURANCE GROUP LLC
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number80819
Policy instance 3
Insurance contract or identification number80819
Number of Individuals Covered565
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $300,226
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $263,197
Amount paid for insurance broker fees255361
Additional information about fees paid to insurance brokerCONTRACT ADMINISTRATORS
Insurance broker organization code?5
Insurance broker nameEASTERN INSURANCE GROUP
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05916463
Policy instance 2
Insurance contract or identification numberTM05916463
Number of Individuals Covered1335
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $8,498
Total amount of fees paid to insurance companyUSD $3,795
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $457,206
Commission paid to Insurance BrokerUSD $8,498
Amount paid for insurance broker fees3795
Additional information about fees paid to insurance brokerCARRIER BONUS
Insurance broker organization code?3
Insurance broker nameEASTERN INSURANCE GROUP
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99071500
Policy instance 3
Insurance contract or identification number99071500
Number of Individuals Covered653
Insurance policy start date2013-04-02
Insurance policy end date2014-04-01
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $11
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $225
Amount paid for insurance broker fees11
Additional information about fees paid to insurance brokerGUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number486291
Policy instance 2
Insurance contract or identification number486291
Number of Individuals Covered653
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $24,363
Total amount of fees paid to insurance companyUSD $10,138
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $337,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,363
Amount paid for insurance broker fees10138
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4957125
Policy instance 1
Insurance contract or identification number4957125
Number of Individuals Covered1350
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $12,534
Total amount of fees paid to insurance companyUSD $5,274
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $12,534
Amount paid for insurance broker fees5274
Additional information about fees paid to insurance brokerOTHER COMMISSIONS
Insurance broker organization code?3

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