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WYMAN-GORDON COMPANY OMNIBUS WELFARE BENEFIT PLAN 401k Plan overview

Plan NameWYMAN-GORDON COMPANY OMNIBUS WELFARE BENEFIT PLAN
Plan identification number 501

WYMAN-GORDON COMPANY OMNIBUS WELFARE BENEFIT PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    WYMAN-GORDON COMPANY has sponsored the creation of one or more 401k plans.

    Company Name:WYMAN-GORDON COMPANY
    Employer identification number (EIN):041992780
    NAIC Classification:332110

    Additional information about WYMAN-GORDON COMPANY

    Jurisdiction of Incorporation: Texas Secretary of State
    Incorporation Date: 1955-04-13
    Company Identification Number: 0001660006
    Legal Registered Office Address: 4650 S MACADAM AVE STE 300

    PORTLAND
    United States of America (USA)
    97239

    More information about WYMAN-GORDON COMPANY

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan WYMAN-GORDON COMPANY OMNIBUS WELFARE BENEFIT PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012018-06-01DEBRA M. HARMON2019-12-12
    5012017-06-01
    5012016-06-01
    5012015-06-01MATTHEW DOMENICO
    5012014-06-01MATTHEW DOMENICO
    5012013-06-01MATTHEW DOMENICO
    5012012-06-01KURT LORING
    5012011-06-01ALAN MCWATT
    5012009-06-01ALAN MCWATT

    Plan Statistics for WYMAN-GORDON COMPANY OMNIBUS WELFARE BENEFIT PLAN

    401k plan membership statisitcs for WYMAN-GORDON COMPANY OMNIBUS WELFARE BENEFIT PLAN

    Measure Date Value
    2018
    Total participants, beginning-of-year2018-06-01924
    Total number of active participants reported on line 7a of the Form 55002018-06-01503
    Number of retired or separated participants receiving benefits2018-06-01362
    Number of other retired or separated participants entitled to future benefits2018-06-010
    Total of all active and inactive participants2018-06-01865
    2017
    Total participants, beginning-of-year2017-06-011,086
    Total number of active participants reported on line 7a of the Form 55002017-06-01911
    Number of retired or separated participants receiving benefits2017-06-0113
    Number of other retired or separated participants entitled to future benefits2017-06-010
    Total of all active and inactive participants2017-06-01924
    2016
    Total participants, beginning-of-year2016-06-011,153
    Total number of active participants reported on line 7a of the Form 55002016-06-011,150
    Number of retired or separated participants receiving benefits2016-06-013
    Number of other retired or separated participants entitled to future benefits2016-06-010
    Total of all active and inactive participants2016-06-011,153
    2015
    Total participants, beginning-of-year2015-06-011,178
    Total number of active participants reported on line 7a of the Form 55002015-06-01563
    Number of retired or separated participants receiving benefits2015-06-01590
    Number of other retired or separated participants entitled to future benefits2015-06-010
    Total of all active and inactive participants2015-06-011,153
    2014
    Total participants, beginning-of-year2014-06-011,261
    Total number of active participants reported on line 7a of the Form 55002014-06-01533
    Number of retired or separated participants receiving benefits2014-06-01645
    Number of other retired or separated participants entitled to future benefits2014-06-010
    Total of all active and inactive participants2014-06-011,178
    2013
    Total participants, beginning-of-year2013-06-01563
    Total number of active participants reported on line 7a of the Form 55002013-06-01540
    Number of retired or separated participants receiving benefits2013-06-01721
    Number of other retired or separated participants entitled to future benefits2013-06-010
    Total of all active and inactive participants2013-06-011,261
    2012
    Total participants, beginning-of-year2012-06-01546
    Total number of active participants reported on line 7a of the Form 55002012-06-01563
    Number of retired or separated participants receiving benefits2012-06-01861
    Number of other retired or separated participants entitled to future benefits2012-06-010
    Total of all active and inactive participants2012-06-011,424
    2011
    Total participants, beginning-of-year2011-06-01492
    Total number of active participants reported on line 7a of the Form 55002011-06-01546
    Number of retired or separated participants receiving benefits2011-06-0148
    Number of other retired or separated participants entitled to future benefits2011-06-0114
    Total of all active and inactive participants2011-06-01608
    2009
    Total participants, beginning-of-year2009-06-01560
    Total number of active participants reported on line 7a of the Form 55002009-06-01505
    Number of retired or separated participants receiving benefits2009-06-0119
    Number of other retired or separated participants entitled to future benefits2009-06-010
    Total of all active and inactive participants2009-06-01524

    Form 5500 Responses

    2018
    2018-06-01Type of plan entitySingle employer plan
    2018-06-01Submission has been amendedNo
    2018-06-01This submission is the final filingNo
    2018-06-01This return/report is a short plan year return/report (less than 12 months)No
    2018-06-01Plan is a collectively bargained planYes
    2018-06-01Plan funding arrangement – InsuranceYes
    2018-06-01Plan funding arrangement – General assets of the sponsorYes
    2018-06-01Plan benefit arrangement – InsuranceYes
    2018-06-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-06-01Type of plan entityMulti-employer plan
    2017-06-01Submission has been amendedNo
    2017-06-01This submission is the final filingNo
    2017-06-01This return/report is a short plan year return/report (less than 12 months)No
    2017-06-01Plan is a collectively bargained planNo
    2017-06-01Plan funding arrangement – InsuranceYes
    2017-06-01Plan funding arrangement – General assets of the sponsorYes
    2017-06-01Plan benefit arrangement – InsuranceYes
    2017-06-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-06-01Type of plan entityMulti-employer plan
    2016-06-01Submission has been amendedNo
    2016-06-01This submission is the final filingNo
    2016-06-01This return/report is a short plan year return/report (less than 12 months)No
    2016-06-01Plan is a collectively bargained planNo
    2016-06-01Plan funding arrangement – InsuranceYes
    2016-06-01Plan funding arrangement – General assets of the sponsorYes
    2016-06-01Plan benefit arrangement – InsuranceYes
    2016-06-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-06-01Type of plan entityMulti-employer plan
    2015-06-01Submission has been amendedNo
    2015-06-01This submission is the final filingNo
    2015-06-01This return/report is a short plan year return/report (less than 12 months)No
    2015-06-01Plan is a collectively bargained planNo
    2015-06-01Plan funding arrangement – InsuranceYes
    2015-06-01Plan funding arrangement – General assets of the sponsorYes
    2015-06-01Plan benefit arrangement – InsuranceYes
    2015-06-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-06-01Type of plan entityMulti-employer plan
    2014-06-01Submission has been amendedNo
    2014-06-01This submission is the final filingNo
    2014-06-01This return/report is a short plan year return/report (less than 12 months)No
    2014-06-01Plan is a collectively bargained planNo
    2014-06-01Plan funding arrangement – InsuranceYes
    2014-06-01Plan funding arrangement – General assets of the sponsorYes
    2014-06-01Plan benefit arrangement – InsuranceYes
    2014-06-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-06-01Type of plan entityMulti-employer plan
    2013-06-01Submission has been amendedNo
    2013-06-01This submission is the final filingNo
    2013-06-01This return/report is a short plan year return/report (less than 12 months)No
    2013-06-01Plan is a collectively bargained planNo
    2013-06-01Plan funding arrangement – InsuranceYes
    2013-06-01Plan funding arrangement – General assets of the sponsorYes
    2013-06-01Plan benefit arrangement – InsuranceYes
    2013-06-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-06-01Type of plan entityMulti-employer plan
    2012-06-01Submission has been amendedNo
    2012-06-01This submission is the final filingNo
    2012-06-01This return/report is a short plan year return/report (less than 12 months)No
    2012-06-01Plan is a collectively bargained planNo
    2012-06-01Plan funding arrangement – InsuranceYes
    2012-06-01Plan funding arrangement – General assets of the sponsorYes
    2012-06-01Plan benefit arrangement – InsuranceYes
    2012-06-01Plan benefit arrangement – General assets of the sponsorYes
    2011
    2011-06-01Type of plan entityMulti-employer plan
    2011-06-01Submission has been amendedNo
    2011-06-01This submission is the final filingNo
    2011-06-01This return/report is a short plan year return/report (less than 12 months)No
    2011-06-01Plan is a collectively bargained planNo
    2011-06-01Plan funding arrangement – InsuranceYes
    2011-06-01Plan funding arrangement – General assets of the sponsorYes
    2011-06-01Plan benefit arrangement – InsuranceYes
    2011-06-01Plan benefit arrangement – General assets of the sponsorYes
    2009
    2009-06-01Type of plan entityMulti-employer plan
    2009-06-01Submission has been amendedNo
    2009-06-01This submission is the final filingNo
    2009-06-01This return/report is a short plan year return/report (less than 12 months)No
    2009-06-01Plan is a collectively bargained planNo
    2009-06-01Plan funding arrangement – InsuranceYes
    2009-06-01Plan funding arrangement – General assets of the sponsorYes
    2009-06-01Plan benefit arrangement – InsuranceYes
    2009-06-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number4128065/5768065
    Policy instance 8
    Insurance contract or identification number4128065/5768065
    Number of Individuals Covered24
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $188,298
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C04
    Policy instance 3
    Insurance contract or identification numberC002238576C04
    Number of Individuals Covered116
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $533,461
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C01
    Policy instance 2
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered39
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $353,367
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C01
    Policy instance 1
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered872
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $6,506,057
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C05
    Policy instance 4
    Insurance contract or identification numberC002238576C05
    Number of Individuals Covered15
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $140,940
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C06
    Policy instance 7
    Insurance contract or identification numberC002238576C06
    Number of Individuals Covered45
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $285,275
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161 S001
    Policy instance 6
    Insurance contract or identification number779161 S001
    Number of Individuals Covered202
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $1,168,805
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C07
    Policy instance 5
    Insurance contract or identification numberC002238576C07
    Number of Individuals Covered92
    Insurance policy start date2018-06-01
    Insurance policy end date2019-05-31
    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 $579,942
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C01
    Policy instance 2
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered29
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    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 $292,031
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number4128065/5768065
    Policy instance 8
    Insurance contract or identification number4128065/5768065
    Number of Individuals Covered29
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    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 $208,980
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161 S001
    Policy instance 6
    Insurance contract or identification number779161 S001
    Number of Individuals Covered154
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    Total amount of commissions paid to insurance brokerUSD $650
    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 $726,513
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C06
    Policy instance 7
    Insurance contract or identification numberC002238576C06
    Number of Individuals Covered25
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    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 $307,235
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C04
    Policy instance 3
    Insurance contract or identification numberC002238576C04
    Number of Individuals Covered134
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    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 $603,661
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C01
    Policy instance 1
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered907
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    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 $5,878,119
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C07
    Policy instance 5
    Insurance contract or identification numberC002238576C07
    Number of Individuals Covered115
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    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 $548,512
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C05
    Policy instance 4
    Insurance contract or identification numberC002238576C05
    Number of Individuals Covered22
    Insurance policy start date2017-06-01
    Insurance policy end date2018-05-31
    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 $85,308
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number04128065 ET AL
    Policy instance 4
    Insurance contract or identification number04128065 ET AL
    Number of Individuals Covered46
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $241,478
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576 ET A
    Policy instance 3
    Insurance contract or identification numberC002238576 ET A
    Number of Individuals Covered1488
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $8,466,520
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161 S001
    Policy instance 1
    Insurance contract or identification number779161 S001
    Number of Individuals Covered126
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $573,945
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C06
    Policy instance 2
    Insurance contract or identification numberC002238576C06
    Number of Individuals Covered51
    Insurance policy start date2015-06-01
    Insurance policy end date2016-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $382,757
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C06
    Policy instance 4
    Insurance contract or identification numberC002238576C06
    Number of Individuals Covered40
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $180,603
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576 ET A
    Policy instance 3
    Insurance contract or identification numberC002238576 ET A
    Number of Individuals Covered1275
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $7,691,224
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number04128065 ET AL
    Policy instance 1
    Insurance contract or identification number04128065 ET AL
    Number of Individuals Covered47
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $231,990
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161
    Policy instance 2
    Insurance contract or identification number779161
    Number of Individuals Covered97
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $463,790
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C01,C
    Policy instance 4
    Insurance contract or identification numberC002238576C01,C
    Number of Individuals Covered47
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $4,118
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $328,684
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,118
    Insurance broker organization code?3
    Insurance broker nameMERCER HEALTH & BENEFITS
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C01
    Policy instance 3
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered1279
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $81,894
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $7,213,330
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $81,894
    Insurance broker organization code?3
    Insurance broker nameMERCER HEALTH & BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number04128065 ET AL
    Policy instance 1
    Insurance contract or identification number04128065 ET AL
    Number of Individuals Covered57
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $248,640
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161
    Policy instance 2
    Insurance contract or identification number779161
    Number of Individuals Covered85
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $9,403
    Total amount of fees paid to insurance companyUSD $468
    Are there contracts with allocated funds for individual policies?No
    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 $472,658
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,403
    Amount paid for insurance broker fees468
    Additional information about fees paid to insurance brokerMARKET SERVICE REVENUE
    Insurance broker organization code?3
    Insurance broker nameMERCER HEALTH & BENEFITS
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161
    Policy instance 2
    Insurance contract or identification number779161
    Number of Individuals Covered100
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $10,300
    Total amount of fees paid to insurance companyUSD $430
    Are there contracts with allocated funds for individual policies?No
    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 $514,975
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,300
    Amount paid for insurance broker fees430
    Additional information about fees paid to insurance brokerMARKET SERVICE REVENUE
    Insurance broker organization code?3
    Insurance broker nameMERCER HEALTH & BENEFITS
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C01
    Policy instance 3
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered1332
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $94,415
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $6,640,491
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $94,415
    Insurance broker organization code?3
    Insurance broker nameMERCER HEALTH & BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number04128065 ET AL
    Policy instance 1
    Insurance contract or identification number04128065 ET AL
    Number of Individuals Covered57
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $259,000
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C01,C
    Policy instance 4
    Insurance contract or identification numberC002238576C01,C
    Number of Individuals Covered54
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $3,726
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $390,326
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,726
    Insurance broker organization code?3
    Insurance broker nameMERCER HEALTH & BENEFITS
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number04128065 ET AL
    Policy instance 4
    Insurance contract or identification number04128065 ET AL
    Number of Individuals Covered59
    Insurance policy start date2011-06-01
    Insurance policy end date2012-05-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $265,648
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161
    Policy instance 1
    Insurance contract or identification number779161
    Number of Individuals Covered93
    Insurance policy start date2011-06-01
    Insurance policy end date2012-05-31
    Total amount of commissions paid to insurance brokerUSD $8,854
    Total amount of fees paid to insurance companyUSD $1,120
    Are there contracts with allocated funds for individual policies?No
    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 $442,658
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract numberC002238576C01
    Policy instance 2
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered47
    Insurance policy start date2011-06-01
    Insurance policy end date2012-05-31
    Total amount of commissions paid to insurance brokerUSD $4,302
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $387,046
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract numberC002238576C01
    Policy instance 3
    Insurance contract or identification numberC002238576C01
    Number of Individuals Covered1329
    Insurance policy start date2011-06-01
    Insurance policy end date2012-05-31
    Total amount of commissions paid to insurance brokerUSD $96,860
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $6,892,059
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
    Policy contract number2243378 ET AL
    Policy instance 3
    Insurance contract or identification number2243378 ET AL
    Number of Individuals Covered1214
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $87,064
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $7,147,466
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
    Policy contract number779161
    Policy instance 1
    Insurance contract or identification number779161
    Number of Individuals Covered40
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $7,895
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $394,729
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number04128065 ET AL
    Policy instance 4
    Insurance contract or identification number04128065 ET AL
    Number of Individuals Covered62
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $241
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $303,798
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
    Policy contract number9980096 ET AL
    Policy instance 2
    Insurance contract or identification number9980096 ET AL
    Number of Individuals Covered48
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $5,072
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    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 $566,335
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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