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SOUTH COVE COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan NameSOUTH COVE COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN
Plan identification number 501

SOUTH COVE COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    SOUTH COVE COMMUNITY HEALTH CENTER, INC. has sponsored the creation of one or more 401k plans.

    Company Name:SOUTH COVE COMMUNITY HEALTH CENTER, INC.
    Employer identification number (EIN):042501818
    NAIC Classification:621498
    NAIC Description:All Other Outpatient Care Centers

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan SOUTH COVE COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-07-01ERIC TIBERI2020-11-19
    5012018-07-01ERIC TIBERI2020-01-22
    5012017-07-01EUGENE WELCH2019-04-02
    5012016-07-01
    5012015-07-01EUGENE WELCH
    5012014-07-01EUGENE WELCH
    5012013-07-01ERIC TIBERI
    5012012-07-01EUGENE WELCH
    5012011-07-01EUGENE WELCH
    5012010-07-01EUGENE WELCH
    5012009-07-01EUGENE WELCH
    5012008-07-01EUGENE WELCH

    Plan Statistics for SOUTH COVE COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN

    401k plan membership statisitcs for SOUTH COVE COMMUNITY HEALTH CENTER EMPLOYEE BENEFITS PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-07-01167
    Total number of active participants reported on line 7a of the Form 55002019-07-01235
    Number of retired or separated participants receiving benefits2019-07-010
    Number of other retired or separated participants entitled to future benefits2019-07-010
    Total of all active and inactive participants2019-07-01235
    Number of employers contributing to the scheme2019-07-010
    2018
    Total participants, beginning-of-year2018-07-01230
    Total number of active participants reported on line 7a of the Form 55002018-07-01167
    Number of retired or separated participants receiving benefits2018-07-010
    Number of other retired or separated participants entitled to future benefits2018-07-010
    Total of all active and inactive participants2018-07-01167
    Number of employers contributing to the scheme2018-07-010
    2017
    Total participants, beginning-of-year2017-07-01216
    Total number of active participants reported on line 7a of the Form 55002017-07-01230
    Number of retired or separated participants receiving benefits2017-07-010
    Number of other retired or separated participants entitled to future benefits2017-07-010
    Total of all active and inactive participants2017-07-01230
    Number of employers contributing to the scheme2017-07-010
    2016
    Total participants, beginning-of-year2016-07-01202
    Total number of active participants reported on line 7a of the Form 55002016-07-01216
    Number of retired or separated participants receiving benefits2016-07-010
    Number of other retired or separated participants entitled to future benefits2016-07-010
    Total of all active and inactive participants2016-07-01216
    2015
    Total participants, beginning-of-year2015-07-01160
    Total number of active participants reported on line 7a of the Form 55002015-07-01202
    Number of retired or separated participants receiving benefits2015-07-010
    Number of other retired or separated participants entitled to future benefits2015-07-010
    Total of all active and inactive participants2015-07-01202
    2014
    Total participants, beginning-of-year2014-07-01201
    Total number of active participants reported on line 7a of the Form 55002014-07-01159
    Number of retired or separated participants receiving benefits2014-07-011
    Number of other retired or separated participants entitled to future benefits2014-07-010
    Total of all active and inactive participants2014-07-01160
    2013
    Total participants, beginning-of-year2013-07-01186
    Total number of active participants reported on line 7a of the Form 55002013-07-01201
    Number of retired or separated participants receiving benefits2013-07-010
    Number of other retired or separated participants entitled to future benefits2013-07-010
    Total of all active and inactive participants2013-07-01201
    2012
    Total participants, beginning-of-year2012-07-01175
    Total number of active participants reported on line 7a of the Form 55002012-07-01186
    Number of retired or separated participants receiving benefits2012-07-010
    Number of other retired or separated participants entitled to future benefits2012-07-010
    Total of all active and inactive participants2012-07-01186
    2011
    Total participants, beginning-of-year2011-07-01169
    Total number of active participants reported on line 7a of the Form 55002011-07-01175
    Number of retired or separated participants receiving benefits2011-07-010
    Number of other retired or separated participants entitled to future benefits2011-07-010
    Total of all active and inactive participants2011-07-01175
    2010
    Total participants, beginning-of-year2010-07-01173
    Total number of active participants reported on line 7a of the Form 55002010-07-01169
    Number of retired or separated participants receiving benefits2010-07-010
    Number of other retired or separated participants entitled to future benefits2010-07-010
    Total of all active and inactive participants2010-07-01169
    2009
    Total participants, beginning-of-year2009-07-01166
    Total number of active participants reported on line 7a of the Form 55002009-07-01173
    Number of retired or separated participants receiving benefits2009-07-010
    Number of other retired or separated participants entitled to future benefits2009-07-010
    Total of all active and inactive participants2009-07-01173
    2008
    Total participants, beginning-of-year2008-07-01157
    Total number of active participants reported on line 7a of the Form 55002008-07-01166
    Number of retired or separated participants receiving benefits2008-07-010
    Number of other retired or separated participants entitled to future benefits2008-07-010
    Total of all active and inactive participants2008-07-01166

    Form 5500 Responses

    2019
    2019-07-01Type of plan entitySingle employer plan
    2019-07-01Plan funding arrangement – InsuranceYes
    2019-07-01Plan funding arrangement – General assets of the sponsorYes
    2019-07-01Plan benefit arrangement – InsuranceYes
    2019-07-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-07-01Type of plan entitySingle employer plan
    2018-07-01Plan funding arrangement – InsuranceYes
    2018-07-01Plan funding arrangement – General assets of the sponsorYes
    2018-07-01Plan benefit arrangement – InsuranceYes
    2018-07-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-07-01Type of plan entitySingle employer plan
    2017-07-01Plan funding arrangement – InsuranceYes
    2017-07-01Plan funding arrangement – General assets of the sponsorYes
    2017-07-01Plan benefit arrangement – InsuranceYes
    2017-07-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-07-01Type of plan entitySingle employer plan
    2016-07-01Submission has been amendedNo
    2016-07-01This submission is the final filingNo
    2016-07-01This return/report is a short plan year return/report (less than 12 months)No
    2016-07-01Plan is a collectively bargained planNo
    2016-07-01Plan funding arrangement – InsuranceYes
    2016-07-01Plan funding arrangement – General assets of the sponsorYes
    2016-07-01Plan benefit arrangement – InsuranceYes
    2016-07-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-07-01Type of plan entitySingle employer plan
    2015-07-01Submission has been amendedNo
    2015-07-01This submission is the final filingNo
    2015-07-01This return/report is a short plan year return/report (less than 12 months)No
    2015-07-01Plan is a collectively bargained planNo
    2015-07-01Plan funding arrangement – InsuranceYes
    2015-07-01Plan funding arrangement – General assets of the sponsorYes
    2015-07-01Plan benefit arrangement – InsuranceYes
    2015-07-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-07-01Type of plan entitySingle employer plan
    2014-07-01Submission has been amendedNo
    2014-07-01This submission is the final filingNo
    2014-07-01This return/report is a short plan year return/report (less than 12 months)No
    2014-07-01Plan is a collectively bargained planNo
    2014-07-01Plan funding arrangement – InsuranceYes
    2014-07-01Plan funding arrangement – General assets of the sponsorYes
    2014-07-01Plan benefit arrangement – InsuranceYes
    2014-07-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-07-01Type of plan entitySingle employer plan
    2013-07-01Submission has been amendedNo
    2013-07-01This submission is the final filingNo
    2013-07-01This return/report is a short plan year return/report (less than 12 months)No
    2013-07-01Plan is a collectively bargained planNo
    2013-07-01Plan funding arrangement – InsuranceYes
    2013-07-01Plan funding arrangement – General assets of the sponsorYes
    2013-07-01Plan benefit arrangement – InsuranceYes
    2013-07-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-07-01Type of plan entitySingle employer plan
    2012-07-01Submission has been amendedNo
    2012-07-01This submission is the final filingNo
    2012-07-01This return/report is a short plan year return/report (less than 12 months)No
    2012-07-01Plan is a collectively bargained planNo
    2012-07-01Plan funding arrangement – InsuranceYes
    2012-07-01Plan funding arrangement – General assets of the sponsorYes
    2012-07-01Plan benefit arrangement – InsuranceYes
    2012-07-01Plan benefit arrangement – General assets of the sponsorYes
    2011
    2011-07-01Type of plan entitySingle employer plan
    2011-07-01Submission has been amendedNo
    2011-07-01This submission is the final filingNo
    2011-07-01This return/report is a short plan year return/report (less than 12 months)No
    2011-07-01Plan is a collectively bargained planNo
    2011-07-01Plan funding arrangement – InsuranceYes
    2011-07-01Plan funding arrangement – General assets of the sponsorYes
    2011-07-01Plan benefit arrangement – InsuranceYes
    2011-07-01Plan benefit arrangement – General assets of the sponsorYes
    2010
    2010-07-01Type of plan entitySingle employer plan
    2010-07-01Submission has been amendedNo
    2010-07-01This submission is the final filingNo
    2010-07-01This return/report is a short plan year return/report (less than 12 months)No
    2010-07-01Plan is a collectively bargained planNo
    2010-07-01Plan funding arrangement – InsuranceYes
    2010-07-01Plan funding arrangement – General assets of the sponsorYes
    2010-07-01Plan benefit arrangement – InsuranceYes
    2010-07-01Plan benefit arrangement – General assets of the sponsorYes
    2009
    2009-07-01Type of plan entitySingle employer plan
    2009-07-01Submission has been amendedNo
    2009-07-01This submission is the final filingNo
    2009-07-01This return/report is a short plan year return/report (less than 12 months)No
    2009-07-01Plan is a collectively bargained planNo
    2009-07-01Plan funding arrangement – InsuranceYes
    2009-07-01Plan funding arrangement – General assets of the sponsorYes
    2009-07-01Plan benefit arrangement – InsuranceYes
    2009-07-01Plan benefit arrangement – General assets of the sponsorYes
    2008
    2008-07-01Type of plan entitySingle employer plan
    2008-07-01First time form 5500 has been submittedYes
    2008-07-01Submission has been amendedNo
    2008-07-01This submission is the final filingNo
    2008-07-01This return/report is a short plan year return/report (less than 12 months)No
    2008-07-01Plan is a collectively bargained planNo
    2008-07-01Plan funding arrangement – InsuranceYes
    2008-07-01Plan funding arrangement – General assets of the sponsorYes
    2008-07-01Plan benefit arrangement – InsuranceYes
    2008-07-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract number5756684
    Policy instance 2
    Insurance contract or identification number5756684
    Number of Individuals Covered235
    Insurance policy start date2019-07-01
    Insurance policy end date2020-06-30
    Total amount of commissions paid to insurance brokerUSD $13,054
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $147,726
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,054
    Insurance broker organization code?3
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number50217000
    Policy instance 1
    Insurance contract or identification number50217000
    Number of Individuals Covered421
    Insurance policy start date2019-07-01
    Insurance policy end date2020-06-30
    Total amount of commissions paid to insurance brokerUSD $43,516
    Total amount of fees paid to insurance companyUSD $25,197
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $2,324,093
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $43,516
    Amount paid for insurance broker fees25197
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number50217000
    Policy instance 1
    Insurance contract or identification number50217000
    Number of Individuals Covered392
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $43,402
    Total amount of fees paid to insurance companyUSD $30,286
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $2,332,131
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract number5756684
    Policy instance 2
    Insurance contract or identification number5756684
    Number of Individuals Covered233
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $12,983
    Total amount of fees paid to insurance companyUSD $55
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $147,240
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05756684
    Policy instance 2
    Insurance contract or identification numberTM05756684
    Number of Individuals Covered230
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $12,559
    Total amount of fees paid to insurance companyUSD $618
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $142,465
    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 number50217000
    Policy instance 1
    Insurance contract or identification number50217000
    Number of Individuals Covered387
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $42,637
    Total amount of fees paid to insurance companyUSD $22,638
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $2,269,362
    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 number50217000
    Policy instance 1
    Insurance contract or identification number50217000
    Number of Individuals Covered348
    Insurance policy start date2015-07-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $41,923
    Total amount of fees paid to insurance companyUSD $23,628
    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 $2,172,786
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $41,923
    Amount paid for insurance broker fees23628
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05756684
    Policy instance 2
    Insurance contract or identification numberTM05756684
    Number of Individuals Covered202
    Insurance policy start date2015-07-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $11,807
    Total amount of fees paid to insurance companyUSD $1,064
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $134,216
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,807
    Amount paid for insurance broker fees1064
    Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number50217000
    Policy instance 1
    Insurance contract or identification number50217000
    Number of Individuals Covered376
    Insurance policy start date2014-07-01
    Insurance policy end date2015-06-30
    Total amount of commissions paid to insurance brokerUSD $41,711
    Total amount of fees paid to insurance companyUSD $25,439
    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 $2,117,687
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $41,711
    Amount paid for insurance broker fees25439
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05756684
    Policy instance 2
    Insurance contract or identification numberTM05756684
    Number of Individuals Covered201
    Insurance policy start date2014-07-01
    Insurance policy end date2015-06-30
    Total amount of commissions paid to insurance brokerUSD $10,882
    Total amount of fees paid to insurance companyUSD $597
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $123,163
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,882
    Amount paid for insurance broker fees597
    Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05756684
    Policy instance 2
    Insurance contract or identification numberTM05756684
    Number of Individuals Covered201
    Insurance policy start date2013-07-01
    Insurance policy end date2014-06-30
    Total amount of commissions paid to insurance brokerUSD $9,354
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $114,245
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,354
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number50217000
    Policy instance 1
    Insurance contract or identification number50217000
    Number of Individuals Covered134
    Insurance policy start date2013-07-01
    Insurance policy end date2014-06-30
    Total amount of commissions paid to insurance brokerUSD $39,665
    Total amount of fees paid to insurance companyUSD $15,518
    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 $1,967,290
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $39,665
    Amount paid for insurance broker fees15518
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number50217000
    Policy instance 1
    Insurance contract or identification number50217000
    Number of Individuals Covered142
    Insurance policy start date2012-07-01
    Insurance policy end date2013-06-30
    Total amount of commissions paid to insurance brokerUSD $36,497
    Total amount of fees paid to insurance companyUSD $8,922
    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 $1,961,277
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $36,497
    Amount paid for insurance broker fees8922
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05756684
    Policy instance 2
    Insurance contract or identification numberTM05756684
    Number of Individuals Covered186
    Insurance policy start date2012-07-01
    Insurance policy end date2013-06-30
    Total amount of commissions paid to insurance brokerUSD $8,827
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $104,492
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,827
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number78628000
    Policy instance 1
    Insurance contract or identification number78628000
    Number of Individuals Covered138
    Insurance policy start date2011-07-01
    Insurance policy end date2012-06-30
    Total amount of commissions paid to insurance brokerUSD $54,928
    Total amount of fees paid to insurance companyUSD $10,837
    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 $1,912,574
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05756684
    Policy instance 2
    Insurance contract or identification numberTM05756684
    Number of Individuals Covered175
    Insurance policy start date2011-07-01
    Insurance policy end date2012-06-30
    Total amount of commissions paid to insurance brokerUSD $7,790
    Total amount of fees paid to insurance companyUSD $1,002
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $91,315
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract numberTM05756684
    Policy instance 2
    Insurance contract or identification numberTM05756684
    Number of Individuals Covered169
    Insurance policy start date2010-07-01
    Insurance policy end date2011-06-30
    Total amount of commissions paid to insurance brokerUSD $6,628
    Total amount of fees paid to insurance companyUSD $1,541
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $77,240
    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 number64078000
    Policy instance 1
    Insurance contract or identification number64078000
    Number of Individuals Covered134
    Insurance policy start date2010-07-01
    Insurance policy end date2011-06-30
    Total amount of commissions paid to insurance brokerUSD $47,020
    Total amount of fees paid to insurance companyUSD $24,465
    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 $1,851,021
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10018181
    Policy instance 2
    Insurance contract or identification number10018181
    Number of Individuals Covered166
    Insurance policy start date2008-07-01
    Insurance policy end date2009-06-30
    Total amount of commissions paid to insurance brokerUSD $15,262
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    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 $125,333
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,262
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number64078000
    Policy instance 1
    Insurance contract or identification number64078000
    Number of Individuals Covered128
    Insurance policy start date2008-07-01
    Insurance policy end date2009-06-30
    Total amount of commissions paid to insurance brokerUSD $37,635
    Total amount of fees paid to insurance companyUSD $9,143
    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 $1,274,974
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $37,635
    Amount paid for insurance broker fees9143
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCES., INC.

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