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KENNEDY- DONOVAN CENTER HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameKENNEDY- DONOVAN CENTER HEALTH AND WELFARE PLAN
Plan identification number 501

KENNEDY- DONOVAN CENTER HEALTH AND WELFARE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    KENNEDY - DONOVAN CENTER, INC has sponsored the creation of one or more 401k plans.

    Company Name:KENNEDY - DONOVAN CENTER, INC
    Employer identification number (EIN):042519028
    NAIC Classification:624100
    NAIC Description: Individual and Family Services

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan KENNEDY- DONOVAN CENTER HEALTH AND WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012017-07-01GLEN MATTERA GLEN MATTERA2019-01-30
    5012016-07-01AUBREY MACFARLANE
    5012015-09-01AUBREY MACFARLANE
    5012014-09-01RICK BORNSTEIN
    5012013-09-01KERI SERVAIS
    5012012-09-01KERI SERVAIS
    5012011-09-01KERI SERVAIS
    5012010-09-01GINA-MARIE NORTON
    5012009-09-01GINA-MARIE NORTON

    Plan Statistics for KENNEDY- DONOVAN CENTER HEALTH AND WELFARE PLAN

    401k plan membership statisitcs for KENNEDY- DONOVAN CENTER HEALTH AND WELFARE PLAN

    Measure Date Value
    2017
    Total participants, beginning-of-year2017-07-01420
    Total number of active participants reported on line 7a of the Form 55002017-07-01420
    Number of retired or separated participants receiving benefits2017-07-015
    Total of all active and inactive participants2017-07-01425
    Total participants2017-07-01425
    2016
    Total participants, beginning-of-year2016-07-01423
    Total number of active participants reported on line 7a of the Form 55002016-07-01420
    Number of retired or separated participants receiving benefits2016-07-016
    Number of other retired or separated participants entitled to future benefits2016-07-010
    Total of all active and inactive participants2016-07-01426
    2015
    Total participants, beginning-of-year2015-09-01410
    Total number of active participants reported on line 7a of the Form 55002015-09-01420
    Number of retired or separated participants receiving benefits2015-09-013
    Total of all active and inactive participants2015-09-01423
    2014
    Total participants, beginning-of-year2014-09-01369
    Total number of active participants reported on line 7a of the Form 55002014-09-01410
    Total of all active and inactive participants2014-09-01410
    2013
    Total participants, beginning-of-year2013-09-01353
    Total number of active participants reported on line 7a of the Form 55002013-09-01369
    Total of all active and inactive participants2013-09-01369
    2012
    Total participants, beginning-of-year2012-09-01356
    Total number of active participants reported on line 7a of the Form 55002012-09-01353
    Number of retired or separated participants receiving benefits2012-09-010
    Total of all active and inactive participants2012-09-01353
    2011
    Total participants, beginning-of-year2011-09-01307
    Total number of active participants reported on line 7a of the Form 55002011-09-01356
    Number of retired or separated participants receiving benefits2011-09-010
    Number of other retired or separated participants entitled to future benefits2011-09-010
    Total of all active and inactive participants2011-09-01356
    2010
    Total participants, beginning-of-year2010-09-01304
    Total number of active participants reported on line 7a of the Form 55002010-09-01307
    Number of retired or separated participants receiving benefits2010-09-010
    Number of other retired or separated participants entitled to future benefits2010-09-010
    Total of all active and inactive participants2010-09-01307
    2009
    Total participants, beginning-of-year2009-09-01290
    Total number of active participants reported on line 7a of the Form 55002009-09-01304
    Number of retired or separated participants receiving benefits2009-09-010
    Number of other retired or separated participants entitled to future benefits2009-09-010
    Total of all active and inactive participants2009-09-01304

    Form 5500 Responses

    2017
    2017-07-01Type of plan entitySingle employer plan
    2017-07-01Submission has been amendedNo
    2017-07-01This submission is the final filingNo
    2017-07-01This return/report is a short plan year return/report (less than 12 months)No
    2017-07-01Plan is a collectively bargained planNo
    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 benefit arrangement – InsuranceYes
    2015
    2015-09-01Type of plan entitySingle employer plan
    2015-09-01Submission has been amendedNo
    2015-09-01This submission is the final filingNo
    2015-09-01This return/report is a short plan year return/report (less than 12 months)Yes
    2015-09-01Plan is a collectively bargained planNo
    2015-09-01Plan funding arrangement – InsuranceYes
    2015-09-01Plan benefit arrangement – InsuranceYes
    2014
    2014-09-01Type of plan entitySingle employer plan
    2014-09-01Submission has been amendedNo
    2014-09-01This submission is the final filingNo
    2014-09-01This return/report is a short plan year return/report (less than 12 months)No
    2014-09-01Plan is a collectively bargained planNo
    2014-09-01Plan funding arrangement – InsuranceYes
    2014-09-01Plan benefit arrangement – InsuranceYes
    2013
    2013-09-01Type of plan entitySingle employer plan
    2013-09-01Submission has been amendedNo
    2013-09-01This submission is the final filingNo
    2013-09-01This return/report is a short plan year return/report (less than 12 months)No
    2013-09-01Plan is a collectively bargained planNo
    2013-09-01Plan funding arrangement – InsuranceYes
    2013-09-01Plan benefit arrangement – InsuranceYes
    2012
    2012-09-01Type of plan entitySingle employer plan
    2012-09-01Submission has been amendedNo
    2012-09-01This submission is the final filingNo
    2012-09-01This return/report is a short plan year return/report (less than 12 months)No
    2012-09-01Plan is a collectively bargained planNo
    2012-09-01Plan funding arrangement – InsuranceYes
    2012-09-01Plan benefit arrangement – InsuranceYes
    2011
    2011-09-01Type of plan entitySingle employer plan
    2011-09-01Submission has been amendedNo
    2011-09-01This submission is the final filingNo
    2011-09-01This return/report is a short plan year return/report (less than 12 months)No
    2011-09-01Plan is a collectively bargained planNo
    2011-09-01Plan funding arrangement – InsuranceYes
    2011-09-01Plan benefit arrangement – InsuranceYes
    2010
    2010-09-01Type of plan entitySingle employer plan
    2010-09-01Submission has been amendedNo
    2010-09-01This submission is the final filingNo
    2010-09-01This return/report is a short plan year return/report (less than 12 months)No
    2010-09-01Plan is a collectively bargained planNo
    2010-09-01Plan funding arrangement – InsuranceYes
    2010-09-01Plan benefit arrangement – InsuranceYes
    2009
    2009-09-01Type of plan entitySingle employer plan
    2009-09-01Submission has been amendedNo
    2009-09-01This submission is the final filingNo
    2009-09-01This return/report is a short plan year return/report (less than 12 months)No
    2009-09-01Plan is a collectively bargained planNo
    2009-09-01Plan funding arrangement – InsuranceYes
    2009-09-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number013671
    Policy instance 5
    Insurance contract or identification number013671
    Number of Individuals Covered463
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $6,543
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
    Policy contract number001200
    Policy instance 4
    Insurance contract or identification number001200
    Number of Individuals Covered374
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $9,040
    Total amount of fees paid to insurance companyUSD $4,219
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    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 $54,279
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4958156
    Policy instance 3
    Insurance contract or identification number4958156
    Number of Individuals Covered342
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $74,501
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
    Policy contract numberF274F9
    Policy instance 2
    Insurance contract or identification numberF274F9
    Number of Individuals Covered420
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $5,037
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    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 $22,895
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10014611001
    Policy instance 1
    Insurance contract or identification number10014611001
    Number of Individuals Covered239
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $1,859
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    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 $21,183
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4958156
    Policy instance 3
    Insurance contract or identification number4958156
    Number of Individuals Covered403
    Insurance policy start date2015-09-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $62,638
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $62,638
    Insurance broker organization code?3
    Insurance broker nameEAST COAST BENEFIT PLANS
    AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
    Policy contract numberF274F9
    Policy instance 2
    Insurance contract or identification numberF274F9
    Number of Individuals Covered420
    Insurance policy start date2015-09-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $26,830
    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 $121,951
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $18,293
    Additional information about fees paid to insurance brokerSERVICE FEE
    Insurance broker organization code?3
    Insurance broker nameINDIGO INSURANCE SVC
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10014611001
    Policy instance 1
    Insurance contract or identification number10014611001
    Number of Individuals Covered267
    Insurance policy start date2015-09-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $1,145
    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 BenefitYes
    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 $11,346
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,145
    Insurance broker organization code?3
    Insurance broker nameEAST COAST BENEFIT PLANS, INC.
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50001735
    Policy instance 3
    Insurance contract or identification number50001735
    Number of Individuals Covered153
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $19,744
    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 BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    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 $78,976
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,744
    Insurance broker organization code?3
    Insurance broker nameINDIGO INSURANCE SERVICES
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number69972000
    Policy instance 1
    Insurance contract or identification number69972000
    Number of Individuals Covered404
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $79,349
    Total amount of fees paid to insurance companyUSD $761
    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 $2,570,250
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $79,349
    Amount paid for insurance broker fees761
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameEAST COAST BENEFITS PLANS
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-015314-00
    Policy instance 2
    Insurance contract or identification number01-015314-00
    Number of Individuals Covered410
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $8,005
    Total amount of fees paid to insurance companyUSD $2,112
    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 BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $53,366
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,005
    Amount paid for insurance broker fees2112
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameEAST COAST BENEFIT PLANS, INC.
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-015314-00
    Policy instance 2
    Insurance contract or identification number01-015314-00
    Number of Individuals Covered369
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $8,066
    Total amount of fees paid to insurance companyUSD $1,548
    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 BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $50,039
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,066
    Amount paid for insurance broker fees1548
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameEAST COAST BENEFIT PLANS, INC.
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number69972000
    Policy instance 1
    Insurance contract or identification number69972000
    Number of Individuals Covered199
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $46,483
    Total amount of fees paid to insurance companyUSD $7,297
    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 $2,947,699
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $48,585
    Insurance broker organization code?3
    Amount paid for insurance broker fees7297
    Additional information about fees paid to insurance brokerBONIS
    Insurance broker nameUSI INSURANCE SERVICES LLC
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50001735
    Policy instance 3
    Insurance contract or identification number50001735
    Number of Individuals Covered147
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $20,905
    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 BenefitNo
    Temporary Disability Insurance Welfare BenefitYes
    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 $83,184
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $20,905
    Insurance broker organization code?3
    Insurance broker nameINDIGO INSURANCE SERVICES
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-015314-00
    Policy instance 2
    Insurance contract or identification number01-015314-00
    Number of Individuals Covered353
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $6,090
    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 BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $40,597
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,534
    Insurance broker organization code?3
    Insurance broker nameEAST COASTBENEFIT PLANS, INC.
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number69972000
    Policy instance 1
    Insurance contract or identification number69972000
    Number of Individuals Covered210
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $45,873
    Total amount of fees paid to insurance companyUSD $24,859
    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 $2,596,990
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $39,536
    Amount paid for insurance broker fees24859
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    Insurance broker nameTD INSURANCE INC.
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-015314-00
    Policy instance 1
    Insurance contract or identification number01-015314-00
    Number of Individuals Covered356
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $6,180
    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 BenefitNo
    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 $41,198
    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 number69972000
    Policy instance 2
    Insurance contract or identification number69972000
    Number of Individuals Covered213
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $59,417
    Total amount of fees paid to insurance companyUSD $1,456
    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 $2,396,558
    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 number69972000
    Policy instance 2
    Insurance contract or identification number69972000
    Number of Individuals Covered194
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $44,113
    Total amount of fees paid to insurance companyUSD $8,306
    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 $1,880,645
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
    Policy contract number01-015314-00
    Policy instance 1
    Insurance contract or identification number01-015314-00
    Number of Individuals Covered307
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $5,968
    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 BenefitNo
    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 $39,789
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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