CAPSTAN ATLANTIC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN
401k plan membership statisitcs for CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN
Measure | Date | Value |
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2021: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-10-01 | 125 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 131 |
Number of retired or separated participants receiving benefits | 2021-10-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
Total of all active and inactive participants | 2021-10-01 | 132 |
2020: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-10-01 | 115 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 125 |
Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
Total of all active and inactive participants | 2020-10-01 | 125 |
2019: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-10-01 | 104 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 115 |
Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
Total of all active and inactive participants | 2019-10-01 | 115 |
2018: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-10-01 | 139 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 189 |
Number of retired or separated participants receiving benefits | 2018-10-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
Total of all active and inactive participants | 2018-10-01 | 190 |
2017: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-10-01 | 137 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 139 |
Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
Total of all active and inactive participants | 2017-10-01 | 139 |
2016: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 134 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 136 |
Number of retired or separated participants receiving benefits | 2016-10-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
Total of all active and inactive participants | 2016-10-01 | 137 |
2015: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 189 |
Number of retired or separated participants receiving benefits | 2015-10-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
Total of all active and inactive participants | 2015-10-01 | 190 |
2014: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-10-01 | 187 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 184 |
Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
Total of all active and inactive participants | 2014-10-01 | 184 |
2013: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-10-01 | 184 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 187 |
Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
Total of all active and inactive participants | 2013-10-01 | 187 |
2012: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-10-01 | 175 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 184 |
Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 0 |
Total of all active and inactive participants | 2012-10-01 | 184 |
2011: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-10-01 | 161 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 175 |
Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 0 |
Total of all active and inactive participants | 2011-10-01 | 175 |
2010: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-10-01 | 160 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 161 |
Number of retired or separated participants receiving benefits | 2010-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 0 |
Total of all active and inactive participants | 2010-10-01 | 161 |
2009: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-10-01 | 159 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 159 |
Number of retired or separated participants receiving benefits | 2009-10-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 0 |
Total of all active and inactive participants | 2009-10-01 | 160 |
2021: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2021 form 5500 responses |
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2021-10-01 | Type of plan entity | Single employer plan |
2021-10-01 | Submission has been amended | No |
2021-10-01 | This submission is the final filing | No |
2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-10-01 | Plan is a collectively bargained plan | No |
2021-10-01 | Plan funding arrangement – Insurance | Yes |
2021-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-10-01 | Plan benefit arrangement – Insurance | Yes |
2021-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2020 form 5500 responses |
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2020-10-01 | Type of plan entity | Single employer plan |
2020-10-01 | Submission has been amended | Yes |
2020-10-01 | This submission is the final filing | No |
2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-10-01 | Plan is a collectively bargained plan | No |
2020-10-01 | Plan funding arrangement – Insurance | Yes |
2020-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-10-01 | Plan benefit arrangement – Insurance | Yes |
2020-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2019 form 5500 responses |
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2019-10-01 | Type of plan entity | Single employer plan |
2019-10-01 | Submission has been amended | No |
2019-10-01 | This submission is the final filing | No |
2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-10-01 | Plan is a collectively bargained plan | No |
2019-10-01 | Plan funding arrangement – Insurance | Yes |
2019-10-01 | Plan benefit arrangement – Insurance | Yes |
2018: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2018 form 5500 responses |
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2018-10-01 | Type of plan entity | Single employer plan |
2018-10-01 | Submission has been amended | No |
2018-10-01 | This submission is the final filing | No |
2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-10-01 | Plan is a collectively bargained plan | No |
2018-10-01 | Plan funding arrangement – Insurance | Yes |
2018-10-01 | Plan benefit arrangement – Insurance | Yes |
2017: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2017 form 5500 responses |
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2017-10-01 | Type of plan entity | Single employer plan |
2017-10-01 | Submission has been amended | No |
2017-10-01 | This submission is the final filing | No |
2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-10-01 | Plan is a collectively bargained plan | No |
2017-10-01 | Plan funding arrangement – Insurance | Yes |
2017-10-01 | Plan benefit arrangement – Insurance | Yes |
2016: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2016 form 5500 responses |
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2016-10-01 | Type of plan entity | Single employer plan |
2016-10-01 | Submission has been amended | No |
2016-10-01 | This submission is the final filing | No |
2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-10-01 | Plan is a collectively bargained plan | No |
2016-10-01 | Plan funding arrangement – Insurance | Yes |
2016-10-01 | Plan benefit arrangement – Insurance | Yes |
2015: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2015 form 5500 responses |
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2015-10-01 | Type of plan entity | Single employer plan |
2015-10-01 | Submission has been amended | No |
2015-10-01 | This submission is the final filing | No |
2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-10-01 | Plan is a collectively bargained plan | No |
2015-10-01 | Plan funding arrangement – Insurance | Yes |
2015-10-01 | Plan benefit arrangement – Insurance | Yes |
2014: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2014 form 5500 responses |
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2014-10-01 | Type of plan entity | Single employer plan |
2014-10-01 | Submission has been amended | No |
2014-10-01 | This submission is the final filing | No |
2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-10-01 | Plan is a collectively bargained plan | No |
2014-10-01 | Plan funding arrangement – Insurance | Yes |
2014-10-01 | Plan benefit arrangement – Insurance | Yes |
2013: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2013 form 5500 responses |
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2013-10-01 | Type of plan entity | Single employer plan |
2013-10-01 | Submission has been amended | No |
2013-10-01 | This submission is the final filing | No |
2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-10-01 | Plan is a collectively bargained plan | No |
2013-10-01 | Plan funding arrangement – Insurance | Yes |
2013-10-01 | Plan benefit arrangement – Insurance | Yes |
2012: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2012 form 5500 responses |
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2012-10-01 | Type of plan entity | Single employer plan |
2012-10-01 | Submission has been amended | No |
2012-10-01 | This submission is the final filing | No |
2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-10-01 | Plan is a collectively bargained plan | No |
2012-10-01 | Plan funding arrangement – Insurance | Yes |
2012-10-01 | Plan benefit arrangement – Insurance | Yes |
2011: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2011 form 5500 responses |
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2011-10-01 | Type of plan entity | Single employer plan |
2011-10-01 | Submission has been amended | No |
2011-10-01 | This submission is the final filing | No |
2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-10-01 | Plan is a collectively bargained plan | No |
2011-10-01 | Plan funding arrangement – Insurance | Yes |
2011-10-01 | Plan benefit arrangement – Insurance | Yes |
2010: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2010 form 5500 responses |
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2010-10-01 | Type of plan entity | Single employer plan |
2010-10-01 | Submission has been amended | No |
2010-10-01 | This submission is the final filing | No |
2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-10-01 | Plan is a collectively bargained plan | No |
2010-10-01 | Plan funding arrangement – Insurance | Yes |
2010-10-01 | Plan benefit arrangement – Insurance | Yes |
2009: CAPSTAN ATLANTIC HEALTH & WELFARE BENEFITS PLAN 2009 form 5500 responses |
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2009-10-01 | Type of plan entity | Single employer plan |
2009-10-01 | First time form 5500 has been submitted | Yes |
2009-10-01 | Submission has been amended | No |
2009-10-01 | This submission is the final filing | No |
2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-10-01 | Plan is a collectively bargained plan | No |
2009-10-01 | Plan funding arrangement – Insurance | Yes |
2009-10-01 | Plan benefit arrangement – Insurance | Yes |
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 005455 |
Policy instance | 2 |
Insurance contract or identification number | 005455 | Number of Individuals Covered | 285 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $3,906 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $115,223 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,906 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
Policy contract number | 971111075430 |
Policy instance | 1 |
Insurance contract or identification number | 971111075430 | Number of Individuals Covered | 192 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $27,987 | Total amount of fees paid to insurance company | USD $18,361 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $46,347 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,987 | Amount paid for insurance broker fees | 18361 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 005455 |
Policy instance | 2 |
Insurance contract or identification number | 005455 | Number of Individuals Covered | 275 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $2,984 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $102,714 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,984 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
Policy contract number | 971111075430 |
Policy instance | 1 |
Insurance contract or identification number | 971111075430 | Number of Individuals Covered | 188 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $30,460 | Total amount of fees paid to insurance company | USD $17,861 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,291,032 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,460 | Amount paid for insurance broker fees | 17861 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
Policy contract number | 971111075430 |
Policy instance | 2 |
Insurance contract or identification number | 971111075430 | Number of Individuals Covered | 183 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $35,497 | Total amount of fees paid to insurance company | USD $18,576 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,423,243 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $35,497 | Amount paid for insurance broker fees | 18576 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 05455 |
Policy instance | 1 |
Insurance contract or identification number | 05455 | Number of Individuals Covered | 261 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $3,620 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $110,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,620 | Insurance broker organization code? | 3 |
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TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
Policy contract number | 971111075430 |
Policy instance | 2 |
Insurance contract or identification number | 971111075430 | Number of Individuals Covered | 199 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $33,971 | Total amount of fees paid to insurance company | USD $15,594 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,290,094 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,971 | Amount paid for insurance broker fees | 15594 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 05455 |
Policy instance | 1 |
Insurance contract or identification number | 05455 | Number of Individuals Covered | 278 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $4,337 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $111,232 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,337 | Insurance broker organization code? | 3 |
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TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
Policy contract number | 6248300 6685200 |
Policy instance | 2 |
Insurance contract or identification number | 6248300 6685200 | Number of Individuals Covered | 183 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $23,591 | Total amount of fees paid to insurance company | USD $11,022 | 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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,018,923 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 ) |
Policy contract number | 05455 |
Policy instance | 1 |
Insurance contract or identification number | 05455 | Number of Individuals Covered | 265 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $4,581 | Total amount of fees paid to insurance company | USD $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 plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $107,663 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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