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ALIMED INC. HEALTH INSURANCE PLAN 401k Plan overview

Plan NameALIMED INC. HEALTH INSURANCE PLAN
Plan identification number 501

ALIMED INC. HEALTH INSURANCE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    ALIMED INCORPORATED has sponsored the creation of one or more 401k plans.

    Company Name:ALIMED INCORPORATED
    Employer identification number (EIN):042577770
    NAIC Classification:423990
    NAIC Description:Other Miscellaneous Durable Goods Merchant Wholesalers

    Additional information about ALIMED INCORPORATED

    Jurisdiction of Incorporation: Colorado Department of State
    Incorporation Date: 1995-09-29
    Company Identification Number: 19951120798
    Legal Registered Office Address: 5520 E 100TH AVE

    Thornton
    United States of America (USA)
    80229

    More information about ALIMED INCORPORATED

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan ALIMED INC. HEALTH INSURANCE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-04-01
    5012018-04-01
    5012017-04-01ALAN MCKINNON
    5012016-04-01JESSICA NISENBAUM
    5012015-04-01JESSICA NISENBAUM JESSICA NISENBAUM2016-10-19
    5012015-04-01JESSICA NISENBAUM
    5012014-04-01LISA YARUSSI LISA YARUSSI2015-10-30
    5012013-04-01WILLIAM DEGIACOMO WILLIAM DEGIACOMO2014-08-13
    5012012-04-01WILLIAM DEGIACOMO WILLIAM DEGIACOMO2013-10-23
    5012011-04-01WILLIAM DEGIACOMO
    5012010-04-01RICHARD HALL

    Plan Statistics for ALIMED INC. HEALTH INSURANCE PLAN

    401k plan membership statisitcs for ALIMED INC. HEALTH INSURANCE PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-04-01204
    Total number of active participants reported on line 7a of the Form 55002019-04-01205
    Number of retired or separated participants receiving benefits2019-04-010
    Number of other retired or separated participants entitled to future benefits2019-04-010
    Total of all active and inactive participants2019-04-01205
    2018
    Total participants, beginning-of-year2018-04-01209
    Total number of active participants reported on line 7a of the Form 55002018-04-01203
    Number of retired or separated participants receiving benefits2018-04-011
    Number of other retired or separated participants entitled to future benefits2018-04-010
    Total of all active and inactive participants2018-04-01204
    2017
    Total participants, beginning-of-year2017-04-01190
    Total number of active participants reported on line 7a of the Form 55002017-04-01207
    Number of retired or separated participants receiving benefits2017-04-012
    Number of other retired or separated participants entitled to future benefits2017-04-010
    Total of all active and inactive participants2017-04-01209
    2016
    Total participants, beginning-of-year2016-04-01198
    Total number of active participants reported on line 7a of the Form 55002016-04-01190
    Number of retired or separated participants receiving benefits2016-04-010
    Number of other retired or separated participants entitled to future benefits2016-04-010
    Total of all active and inactive participants2016-04-01190
    2015
    Total participants, beginning-of-year2015-04-01134
    Total number of active participants reported on line 7a of the Form 55002015-04-01125
    Number of retired or separated participants receiving benefits2015-04-010
    Total of all active and inactive participants2015-04-01125
    Number of other retired or separated participants entitled to future benefits2015-04-010
    2014
    Total participants, beginning-of-year2014-04-01129
    Total number of active participants reported on line 7a of the Form 55002014-04-01134
    Total of all active and inactive participants2014-04-01134
    2013
    Total participants, beginning-of-year2013-04-01133
    Total number of active participants reported on line 7a of the Form 55002013-04-01129
    Total of all active and inactive participants2013-04-01129
    Total participants2013-04-01129
    2012
    Total participants, beginning-of-year2012-04-01117
    Total number of active participants reported on line 7a of the Form 55002012-04-01133
    Total of all active and inactive participants2012-04-01133
    Total participants2012-04-01133
    2011
    Total participants, beginning-of-year2011-04-01120
    Total number of active participants reported on line 7a of the Form 55002011-04-01117
    Number of retired or separated participants receiving benefits2011-04-010
    Number of other retired or separated participants entitled to future benefits2011-04-010
    Total of all active and inactive participants2011-04-01117
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-04-010
    Total participants2011-04-01117
    2010
    Total participants, beginning-of-year2010-04-01121
    Total number of active participants reported on line 7a of the Form 55002010-04-01120
    Number of retired or separated participants receiving benefits2010-04-010
    Number of other retired or separated participants entitled to future benefits2010-04-010
    Total of all active and inactive participants2010-04-01120
    Total participants2010-04-01120

    Form 5500 Responses

    2019
    2019-04-01Type of plan entitySingle employer plan
    2019-04-01Submission has been amendedNo
    2019-04-01This submission is the final filingNo
    2019-04-01This return/report is a short plan year return/report (less than 12 months)No
    2019-04-01Plan is a collectively bargained planNo
    2019-04-01Plan funding arrangement – InsuranceYes
    2019-04-01Plan funding arrangement – General assets of the sponsorYes
    2019-04-01Plan benefit arrangement – InsuranceYes
    2019-04-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-04-01Type of plan entitySingle employer plan
    2018-04-01Submission has been amendedNo
    2018-04-01This submission is the final filingNo
    2018-04-01This return/report is a short plan year return/report (less than 12 months)No
    2018-04-01Plan is a collectively bargained planNo
    2018-04-01Plan funding arrangement – InsuranceYes
    2018-04-01Plan funding arrangement – General assets of the sponsorYes
    2018-04-01Plan benefit arrangement – InsuranceYes
    2018-04-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-04-01Type of plan entitySingle employer plan
    2017-04-01Submission has been amendedNo
    2017-04-01This submission is the final filingNo
    2017-04-01This return/report is a short plan year return/report (less than 12 months)No
    2017-04-01Plan is a collectively bargained planNo
    2017-04-01Plan funding arrangement – InsuranceYes
    2017-04-01Plan funding arrangement – General assets of the sponsorYes
    2017-04-01Plan benefit arrangement – InsuranceYes
    2017-04-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-04-01Type of plan entitySingle employer plan
    2016-04-01Submission has been amendedNo
    2016-04-01This submission is the final filingNo
    2016-04-01This return/report is a short plan year return/report (less than 12 months)No
    2016-04-01Plan is a collectively bargained planNo
    2016-04-01Plan funding arrangement – InsuranceYes
    2016-04-01Plan funding arrangement – General assets of the sponsorYes
    2016-04-01Plan benefit arrangement – InsuranceYes
    2016-04-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-04-01Type of plan entitySingle employer plan
    2015-04-01Submission has been amendedNo
    2015-04-01This submission is the final filingNo
    2015-04-01This return/report is a short plan year return/report (less than 12 months)No
    2015-04-01Plan is a collectively bargained planNo
    2015-04-01Plan funding arrangement – InsuranceYes
    2015-04-01Plan benefit arrangement – InsuranceYes
    2014
    2014-04-01Type of plan entitySingle employer plan
    2014-04-01Submission has been amendedNo
    2014-04-01This submission is the final filingNo
    2014-04-01This return/report is a short plan year return/report (less than 12 months)No
    2014-04-01Plan is a collectively bargained planNo
    2014-04-01Plan funding arrangement – InsuranceYes
    2014-04-01Plan benefit arrangement – InsuranceYes
    2013
    2013-04-01Type of plan entitySingle employer plan
    2013-04-01Submission has been amendedNo
    2013-04-01This submission is the final filingNo
    2013-04-01This return/report is a short plan year return/report (less than 12 months)No
    2013-04-01Plan is a collectively bargained planNo
    2013-04-01Plan funding arrangement – InsuranceYes
    2013-04-01Plan benefit arrangement – InsuranceYes
    2012
    2012-04-01Type of plan entitySingle employer plan
    2012-04-01Submission has been amendedNo
    2012-04-01This submission is the final filingNo
    2012-04-01This return/report is a short plan year return/report (less than 12 months)No
    2012-04-01Plan is a collectively bargained planNo
    2012-04-01Plan funding arrangement – InsuranceYes
    2012-04-01Plan benefit arrangement – InsuranceYes
    2011
    2011-04-01Type of plan entitySingle employer plan
    2011-04-01Submission has been amendedNo
    2011-04-01This submission is the final filingNo
    2011-04-01This return/report is a short plan year return/report (less than 12 months)No
    2011-04-01Plan is a collectively bargained planNo
    2011-04-01Plan funding arrangement – InsuranceYes
    2011-04-01Plan benefit arrangement – InsuranceYes
    2010
    2010-04-01Type of plan entitySingle employer plan
    2010-04-01Submission has been amendedNo
    2010-04-01This submission is the final filingNo
    2010-04-01This return/report is a short plan year return/report (less than 12 months)No
    2010-04-01Plan is a collectively bargained planNo
    2010-04-01Plan funding arrangement – InsuranceYes
    2010-04-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 1
    Insurance contract or identification number4957129
    Number of Individuals Covered221
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $4,394
    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
    Commission paid to Insurance BrokerUSD $4,394
    Insurance broker organization code?3
    NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 )
    Policy contract numberN/A
    Policy instance 7
    Insurance contract or identification numberN/A
    Number of Individuals Covered205
    Insurance policy start date2020-01-01
    Insurance policy end date2020-03-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    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
    Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
    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 $2,090
    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 number10110191001
    Policy instance 6
    Insurance contract or identification number10110191001
    Number of Individuals Covered131
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $859
    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 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 $8,589
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $859
    Insurance broker organization code?3
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 5
    Insurance contract or identification number880706G
    Number of Individuals Covered85
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $6,002
    Total amount of fees paid to insurance companyUSD $2,801
    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 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 $40,013
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,002
    Insurance broker organization code?3
    Amount paid for insurance broker fees2801
    Additional information about fees paid to insurance brokerFEES PAID
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 4
    Insurance contract or identification number880706G
    Number of Individuals Covered181
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $3,540
    Total amount of fees paid to insurance companyUSD $2,156
    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 BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    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 $30,800
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,540
    Insurance broker organization code?3
    Amount paid for insurance broker fees2156
    Additional information about fees paid to insurance brokerFEES PAID
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 3
    Insurance contract or identification number880706G
    Number of Individuals Covered188
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $2,844
    Total amount of fees paid to insurance companyUSD $2,650
    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 BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    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 $37,868
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,844
    Insurance broker organization code?3
    Amount paid for insurance broker fees2650
    Additional information about fees paid to insurance brokerFEES PAID
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 2
    Insurance contract or identification number4957129
    Number of Individuals Covered239
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $37,544
    Total amount of fees paid to insurance companyUSD $12,773
    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
    Commission paid to Insurance BrokerUSD $37,544
    Amount paid for insurance broker fees12773
    Additional information about fees paid to insurance brokerBONUS AND PERSISTENCY COMMISSIONS PAID TO BROKER BY BCBSMA; NOT BILLED TO ACCOUNT
    Insurance broker organization code?3
    NEW DIRECTIONS BEHAVORIAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00369 )
    Policy contract numberN/A
    Policy instance 8
    Insurance contract or identification numberN/A
    Number of Individuals Covered200
    Insurance policy start date2019-01-01
    Insurance policy end date2019-03-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    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
    Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
    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 $500
    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 number4957129
    Policy instance 2
    Insurance contract or identification number4957129
    Number of Individuals Covered247
    Insurance policy start date2018-04-01
    Insurance policy end date2019-03-31
    Total amount of commissions paid to insurance brokerUSD $37,664
    Total amount of fees paid to insurance companyUSD $10,650
    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
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 1
    Insurance contract or identification number4957129
    Number of Individuals Covered225
    Insurance policy start date2018-04-01
    Insurance policy end date2019-03-31
    Total amount of commissions paid to insurance brokerUSD $4,576
    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
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 3
    Insurance contract or identification number880706G
    Number of Individuals Covered204
    Insurance policy start date2018-04-01
    Insurance policy end date2019-03-31
    Total amount of commissions paid to insurance brokerUSD $2,972
    Total amount of fees paid to insurance companyUSD $2,831
    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 BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 4
    Insurance contract or identification number880706G
    Number of Individuals Covered203
    Insurance policy start date2018-04-01
    Insurance policy end date2019-03-31
    Total amount of commissions paid to insurance brokerUSD $3,722
    Total amount of fees paid to insurance companyUSD $2,410
    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 BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 5
    Insurance contract or identification number880706G
    Number of Individuals Covered97
    Insurance policy start date2018-04-01
    Insurance policy end date2019-03-31
    Total amount of commissions paid to insurance brokerUSD $6,753
    Total amount of fees paid to insurance companyUSD $3,151
    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 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
    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 number10110191001
    Policy instance 6
    Insurance contract or identification number10110191001
    Number of Individuals Covered125
    Insurance policy start date2018-04-01
    Insurance policy end date2019-03-31
    Total amount of commissions paid to insurance brokerUSD $880
    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 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 $8,899
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    E4 LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract numberN/A
    Policy instance 7
    Insurance contract or identification numberN/A
    Number of Individuals Covered200
    Insurance policy start date2018-04-01
    Insurance policy end date2018-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    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
    Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
    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 $1,500
    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 number10110191001
    Policy instance 6
    Insurance contract or identification number10110191001
    Number of Individuals Covered112
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $685
    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 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 $7,542
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $685
    Insurance broker organization code?3
    Insurance broker nameHAYS COMPANIES
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 5
    Insurance contract or identification number880706G
    Number of Individuals Covered96
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $6,569
    Total amount of fees paid to insurance companyUSD $3,139
    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 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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,569
    Amount paid for insurance broker fees2171
    Additional information about fees paid to insurance brokerBONUS AND PERSISTANCY
    Insurance broker organization code?3
    Insurance broker nameINDIGO INSURANCE SERVICES
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 4
    Insurance contract or identification number880706G
    Number of Individuals Covered207
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $4,221
    Total amount of fees paid to insurance companyUSD $2,434
    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 BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,221
    Amount paid for insurance broker fees1707
    Additional information about fees paid to insurance brokerBONUS AND PERSISTANCY
    Insurance broker organization code?3
    Insurance broker nameINDIGO INSURANCE SERVICES
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number880706G
    Policy instance 3
    Insurance contract or identification number880706G
    Number of Individuals Covered301
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $3,218
    Total amount of fees paid to insurance companyUSD $2,839
    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 BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,218
    Amount paid for insurance broker fees1993
    Additional information about fees paid to insurance brokerBONUS PAID
    Insurance broker organization code?3
    Insurance broker nameINDIGO INSURANCE SERVICES
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 2
    Insurance contract or identification number4957129
    Number of Individuals Covered262
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $34,008
    Total amount of fees paid to insurance companyUSD $10,200
    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
    Commission paid to Insurance BrokerUSD $34,008
    Amount paid for insurance broker fees10200
    Additional information about fees paid to insurance brokerBONUS AND PERSISTENCY
    Insurance broker organization code?3
    Insurance broker nameTHE HAYS GROUP, INC.
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 1
    Insurance contract or identification number4957129
    Number of Individuals Covered232
    Insurance policy start date2017-04-01
    Insurance policy end date2018-03-31
    Total amount of commissions paid to insurance brokerUSD $3,992
    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
    Commission paid to Insurance BrokerUSD $3,992
    Insurance broker organization code?3
    Insurance broker nameHAYS COMPANIES
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 2
    Insurance contract or identification number4957129
    Number of Individuals Covered212
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $28,362
    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 $28,362
    Insurance broker organization code?3
    Insurance broker name
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 1
    Insurance contract or identification number4957129
    Number of Individuals Covered178
    Insurance policy start date2015-04-01
    Insurance policy end date2016-03-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $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 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
    Commission paid to Insurance BrokerUSD $0
    Insurance broker organization code?3
    Insurance broker name
    DENTAL MAINTENANCE SERVICES INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number280
    Policy instance 1
    Insurance contract or identification number280
    Number of Individuals Covered101
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $7,074
    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 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 $70,749
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,148
    Insurance broker organization code?3
    Insurance broker nameHAYS COMPANIES
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 2
    Insurance contract or identification number4957129
    Number of Individuals Covered233
    Insurance policy start date2014-04-01
    Insurance policy end date2015-03-31
    Total amount of commissions paid to insurance brokerUSD $42,106
    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 $25,011
    Insurance broker organization code?3
    Insurance broker nameTHE HAYS GROUP INC
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 1
    Insurance contract or identification number4957129
    Number of Individuals Covered129
    Insurance policy start date2013-04-01
    Insurance policy end date2014-03-31
    Total amount of commissions paid to insurance brokerUSD $41,016
    Total amount of fees paid to insurance companyUSD $3,193
    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 $1,235,784
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees10965
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Commission paid to Insurance BrokerUSD $30,051
    Insurance broker nameFORSBERG INSURANCE PLANNING
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4957129
    Policy instance 1
    Insurance contract or identification number4957129
    Number of Individuals Covered133
    Insurance policy start date2012-04-01
    Insurance policy end date2013-03-31
    Total amount of commissions paid to insurance brokerUSD $29,501
    Total amount of fees paid to insurance companyUSD $2,636
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,242,138
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $29,501
    Amount paid for insurance broker fees2636
    Additional information about fees paid to insurance brokerTAXES
    Insurance broker nameFORSBERG INSURANCE PLANNING
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number65274000
    Policy instance 1
    Insurance contract or identification number65274000
    Number of Individuals Covered117
    Insurance policy start date2011-04-01
    Insurance policy end date2012-03-31
    Total amount of commissions paid to insurance brokerUSD $38,225
    Total amount of fees paid to insurance companyUSD $1,022
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,144,814
    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 number65274000
    Policy instance 1
    Insurance contract or identification number65274000
    Number of Individuals Covered119
    Insurance policy start date2010-04-01
    Insurance policy end date2011-03-31
    Total amount of commissions paid to insurance brokerUSD $33,444
    Total amount of fees paid to insurance companyUSD $13,226
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,068,783
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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