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BURKE DISTRIBUTING CORPORATION WELFARE BENEFITS PLAN 401k Plan overview

Plan NameBURKE DISTRIBUTING CORPORATION WELFARE BENEFITS PLAN
Plan identification number 501

BURKE DISTRIBUTING CORPORATION WELFARE BENEFITS PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    BURKE DISTRIBUTING CORPORATION has sponsored the creation of one or more 401k plans.

    Company Name:BURKE DISTRIBUTING CORPORATION
    Employer identification number (EIN):042646090
    NAIC Classification:424800

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan BURKE DISTRIBUTING CORPORATION WELFARE BENEFITS PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-10-01WILLIAM G. BURKE2021-01-27
    5012018-10-01WILLIAM G. BURKE2019-11-19
    5012018-10-01WILLIAM G. BURKE2020-02-28
    5012017-10-01
    5012016-10-01
    5012015-10-01
    5012014-10-01
    5012013-10-01CHARLES BALKAM
    5012012-10-01CHARLES BALKAM
    5012011-10-01CHARLES BALKAM
    5012009-10-01CHARLES BALKAM
    5012008-10-01

    Plan Statistics for BURKE DISTRIBUTING CORPORATION WELFARE BENEFITS PLAN

    401k plan membership statisitcs for BURKE DISTRIBUTING CORPORATION WELFARE BENEFITS PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-10-01145
    Total number of active participants reported on line 7a of the Form 55002019-10-01121
    Number of retired or separated participants receiving benefits2019-10-012
    Number of other retired or separated participants entitled to future benefits2019-10-010
    Total of all active and inactive participants2019-10-01123
    2018
    Total participants, beginning-of-year2018-10-01193
    Total number of active participants reported on line 7a of the Form 55002018-10-01144
    Number of retired or separated participants receiving benefits2018-10-011
    Number of other retired or separated participants entitled to future benefits2018-10-010
    Total of all active and inactive participants2018-10-01145
    2017
    Total participants, beginning-of-year2017-10-01188
    Total number of active participants reported on line 7a of the Form 55002017-10-01193
    Number of retired or separated participants receiving benefits2017-10-010
    Number of other retired or separated participants entitled to future benefits2017-10-010
    Total of all active and inactive participants2017-10-01193
    2016
    Total participants, beginning-of-year2016-10-01189
    Total number of active participants reported on line 7a of the Form 55002016-10-01188
    Number of retired or separated participants receiving benefits2016-10-010
    Number of other retired or separated participants entitled to future benefits2016-10-010
    Total of all active and inactive participants2016-10-01188
    2015
    Total participants, beginning-of-year2015-10-01174
    Total number of active participants reported on line 7a of the Form 55002015-10-01186
    Number of retired or separated participants receiving benefits2015-10-013
    Number of other retired or separated participants entitled to future benefits2015-10-010
    Total of all active and inactive participants2015-10-01189
    2014
    Total participants, beginning-of-year2014-10-01162
    Total number of active participants reported on line 7a of the Form 55002014-10-01171
    Number of retired or separated participants receiving benefits2014-10-013
    Number of other retired or separated participants entitled to future benefits2014-10-010
    Total of all active and inactive participants2014-10-01174
    2013
    Total participants, beginning-of-year2013-10-01163
    Total number of active participants reported on line 7a of the Form 55002013-10-01162
    Number of retired or separated participants receiving benefits2013-10-010
    Number of other retired or separated participants entitled to future benefits2013-10-010
    Total of all active and inactive participants2013-10-01162
    2012
    Total participants, beginning-of-year2012-10-01131
    Total number of active participants reported on line 7a of the Form 55002012-10-01163
    Total of all active and inactive participants2012-10-01163
    Total participants2012-10-01163
    2011
    Total participants, beginning-of-year2011-10-01131
    Total number of active participants reported on line 7a of the Form 55002011-10-01131
    Number of retired or separated participants receiving benefits2011-10-010
    Number of other retired or separated participants entitled to future benefits2011-10-010
    Total of all active and inactive participants2011-10-01131
    2009
    Total participants, beginning-of-year2009-10-01152
    Total number of active participants reported on line 7a of the Form 55002009-10-01134
    Number of retired or separated participants receiving benefits2009-10-010
    Number of other retired or separated participants entitled to future benefits2009-10-010
    Total of all active and inactive participants2009-10-01134
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-10-010

    Form 5500 Responses

    2019
    2019-10-01Type of plan entitySingle employer plan
    2019-10-01Submission has been amendedNo
    2019-10-01This submission is the final filingNo
    2019-10-01This return/report is a short plan year return/report (less than 12 months)No
    2019-10-01Plan is a collectively bargained planNo
    2019-10-01Plan funding arrangement – InsuranceYes
    2019-10-01Plan funding arrangement – General assets of the sponsorYes
    2019-10-01Plan benefit arrangement – InsuranceYes
    2019-10-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-10-01Type of plan entitySingle employer plan
    2018-10-01Submission has been amendedNo
    2018-10-01This submission is the final filingNo
    2018-10-01This return/report is a short plan year return/report (less than 12 months)No
    2018-10-01Plan is a collectively bargained planNo
    2018-10-01Plan funding arrangement – InsuranceYes
    2018-10-01Plan funding arrangement – General assets of the sponsorYes
    2018-10-01Plan benefit arrangement – InsuranceYes
    2018-10-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-10-01Type of plan entitySingle employer plan
    2017-10-01Submission has been amendedNo
    2017-10-01This submission is the final filingNo
    2017-10-01This return/report is a short plan year return/report (less than 12 months)No
    2017-10-01Plan is a collectively bargained planNo
    2017-10-01Plan funding arrangement – InsuranceYes
    2017-10-01Plan funding arrangement – General assets of the sponsorYes
    2017-10-01Plan benefit arrangement – InsuranceYes
    2017-10-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-10-01Type of plan entitySingle employer plan
    2016-10-01Submission has been amendedNo
    2016-10-01This submission is the final filingNo
    2016-10-01This return/report is a short plan year return/report (less than 12 months)No
    2016-10-01Plan is a collectively bargained planNo
    2016-10-01Plan funding arrangement – InsuranceYes
    2016-10-01Plan funding arrangement – General assets of the sponsorYes
    2016-10-01Plan benefit arrangement – InsuranceYes
    2016-10-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-10-01Type of plan entitySingle employer plan
    2015-10-01Submission has been amendedNo
    2015-10-01This submission is the final filingNo
    2015-10-01This return/report is a short plan year return/report (less than 12 months)No
    2015-10-01Plan is a collectively bargained planNo
    2015-10-01Plan funding arrangement – InsuranceYes
    2015-10-01Plan funding arrangement – General assets of the sponsorYes
    2015-10-01Plan benefit arrangement – InsuranceYes
    2015-10-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-10-01Type of plan entitySingle employer plan
    2014-10-01Submission has been amendedNo
    2014-10-01This submission is the final filingNo
    2014-10-01This return/report is a short plan year return/report (less than 12 months)No
    2014-10-01Plan is a collectively bargained planNo
    2014-10-01Plan funding arrangement – InsuranceYes
    2014-10-01Plan funding arrangement – General assets of the sponsorYes
    2014-10-01Plan benefit arrangement – InsuranceYes
    2014-10-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-10-01Type of plan entitySingle employer plan
    2013-10-01Submission has been amendedNo
    2013-10-01This submission is the final filingNo
    2013-10-01This return/report is a short plan year return/report (less than 12 months)No
    2013-10-01Plan is a collectively bargained planNo
    2013-10-01Plan funding arrangement – InsuranceYes
    2013-10-01Plan funding arrangement – General assets of the sponsorYes
    2013-10-01Plan benefit arrangement – InsuranceYes
    2013-10-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-10-01Type of plan entitySingle employer plan
    2012-10-01Plan funding arrangement – InsuranceYes
    2012-10-01Plan benefit arrangement – InsuranceYes
    2011
    2011-10-01Type of plan entitySingle employer plan
    2011-10-01Submission has been amendedNo
    2011-10-01This submission is the final filingNo
    2011-10-01This return/report is a short plan year return/report (less than 12 months)No
    2011-10-01Plan is a collectively bargained planNo
    2011-10-01Plan funding arrangement – InsuranceYes
    2011-10-01Plan benefit arrangement – InsuranceYes
    2009
    2009-10-01Type of plan entitySingle employer plan
    2009-10-01Submission has been amendedNo
    2009-10-01This submission is the final filingNo
    2009-10-01This return/report is a short plan year return/report (less than 12 months)No
    2009-10-01Plan is a collectively bargained planNo
    2009-10-01Plan funding arrangement – InsuranceYes
    2009-10-01Plan benefit arrangement – InsuranceYes
    2008
    2008-10-01Type of plan entitySingle employer plan
    2008-10-01Submission has been amendedNo
    2008-10-01This submission is the final filingNo
    2008-10-01This return/report is a short plan year return/report (less than 12 months)No
    2008-10-01Plan is a collectively bargained planNo

    Insurance Providers Used on plan

    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number2078D/S
    Policy instance 2
    Insurance contract or identification number2078D/S
    Number of Individuals Covered2
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $600
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $13,600
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $600
    Insurance broker organization code?3
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered121
    Insurance policy start date2019-10-01
    Insurance policy end date2020-09-30
    Total amount of commissions paid to insurance brokerUSD $9,977
    Total amount of fees paid to insurance companyUSD $3,718
    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 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 $62,492
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,159
    Amount paid for insurance broker fees3718
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number2078D/S
    Policy instance 2
    Insurance contract or identification number2078D/S
    Number of Individuals Covered3
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $595
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $14,940
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered145
    Insurance policy start date2018-10-01
    Insurance policy end date2019-09-30
    Total amount of commissions paid to insurance brokerUSD $11,840
    Total amount of fees paid to insurance companyUSD $3,549
    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 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 $73,379
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered193
    Insurance policy start date2017-10-01
    Insurance policy end date2018-09-30
    Total amount of commissions paid to insurance brokerUSD $12,271
    Total amount of fees paid to insurance companyUSD $4,100
    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 BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    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 $74,999
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,045
    Amount paid for insurance broker fees4100
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    Insurance broker nameDIGITAL INSURANCE LLC
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708000*
    Policy instance 2
    Insurance contract or identification number62708000*
    Number of Individuals Covered340
    Insurance policy start date2015-10-01
    Insurance policy end date2016-09-30
    Total amount of commissions paid to insurance brokerUSD $50,528
    Total amount of fees paid to insurance companyUSD $1,533
    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 $1,706,070
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $50,528
    Amount paid for insurance broker fees1533
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBOSTON COMMONWEALTH ADVANTAGE, LLC
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered186
    Insurance policy start date2015-10-01
    Insurance policy end date2016-09-30
    Total amount of commissions paid to insurance brokerUSD $11,043
    Total amount of fees paid to insurance companyUSD $1,044
    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 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 $65,923
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,723
    Amount paid for insurance broker fees1044
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    Insurance broker nameKENNETH LLOYD
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708065
    Policy instance 3
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2015-10-01
    Insurance policy end date2016-09-30
    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 $17,544
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered171
    Insurance policy start date2014-10-01
    Insurance policy end date2015-09-30
    Total amount of commissions paid to insurance brokerUSD $10,552
    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 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 $61,890
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,334
    Insurance broker organization code?3
    Insurance broker nameKENNETH LLOYD
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708000*
    Policy instance 2
    Insurance contract or identification number62708000*
    Number of Individuals Covered321
    Insurance policy start date2014-10-01
    Insurance policy end date2015-09-30
    Total amount of commissions paid to insurance brokerUSD $47,379
    Total amount of fees paid to insurance companyUSD $12,512
    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 $1,527,173
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $47,379
    Amount paid for insurance broker fees12512
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBOSTON COMMONWEALTH ADVANTAGE, LLC
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708065
    Policy instance 3
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2014-10-01
    Insurance policy end date2015-09-30
    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 $16,278
    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 number62708000 & 8001
    Policy instance 2
    Insurance contract or identification number62708000 & 8001
    Number of Individuals Covered57
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $19,910
    Total amount of fees paid to insurance companyUSD $5,041
    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 $682,068
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,910
    Amount paid for insurance broker fees5041
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBOSTON COMMONWEALTH ADVANTAGE, LLC
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62783000, 3001
    Policy instance 4
    Insurance contract or identification number62783000, 3001
    Number of Individuals Covered85
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $18,750
    Total amount of fees paid to insurance companyUSD $6,165
    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 $680,812
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $18,750
    Amount paid for insurance broker fees6165
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBOSTON COMMONWEALTH ADVANTAGE, LLC
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered162
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    Total amount of commissions paid to insurance brokerUSD $10,840
    Total amount of fees paid to insurance companyUSD $2,114
    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 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 $53,097
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,940
    Amount paid for insurance broker fees2114
    Additional information about fees paid to insurance brokerFEES PAID
    Insurance broker organization code?3
    Insurance broker nameKENNETH LLOYD
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708065
    Policy instance 3
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2013-10-01
    Insurance policy end date2014-09-30
    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 $15,948
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered163
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $11,513
    Total amount of fees paid to insurance companyUSD $1,914
    Dental Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, OPTIONAL AD&D, OPTIONAL LIFE
    Welfare Benefit Premiums Paid to CarrierUSD $55,988
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $966
    Insurance broker organization code?3
    Amount paid for insurance broker fees1914
    Additional information about fees paid to insurance brokerCOMPENSATION
    Insurance broker nameBULFINCH GROUP INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708065
    Policy instance 5
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2013-01-01
    Insurance policy end date2013-09-30
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $11,961
    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 number62783000
    Policy instance 6
    Insurance contract or identification number62783000
    Number of Individuals Covered88
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $22,323
    Total amount of fees paid to insurance companyUSD $1,576
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $743,064
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $22,323
    Amount paid for insurance broker fees1576
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBOSTON COMMONWEALTH ADVANTAGE, LLC
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number863931G
    Policy instance 2
    Insurance contract or identification number863931G
    Number of Individuals Covered146
    Insurance policy start date2011-11-01
    Insurance policy end date2012-10-31
    Total amount of commissions paid to insurance brokerUSD $7,772
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $50,916
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,976
    Insurance broker organization code?3
    Insurance broker nameKENNETH LLOYD
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708000
    Policy instance 3
    Insurance contract or identification number62708000
    Number of Individuals Covered50
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $18,367
    Total amount of fees paid to insurance companyUSD $1,587
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $608,562
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $18,367
    Amount paid for insurance broker fees1587
    Additional information about fees paid to insurance brokerOTHER BROKER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameBOSTON COMMONWEALTH ADVANTAGE, LLC
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number62708065
    Policy instance 4
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2012-10-01
    Insurance policy end date2012-12-31
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $5,127
    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 number62708065
    Policy instance 5
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2012-01-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $38
    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 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 $10,128
    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 number863931G
    Policy instance 2
    Insurance contract or identification number863931G
    Number of Individuals Covered137
    Insurance policy start date2010-11-01
    Insurance policy end date2011-10-31
    Total amount of commissions paid to insurance brokerUSD $7,986
    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 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 $50,652
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered118
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $3,465
    Total amount of fees paid to insurance companyUSD $1,393
    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
    Welfare Benefit Premiums Paid to CarrierUSD $91,635
    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 number62783000
    Policy instance 6
    Insurance contract or identification number62783000
    Number of Individuals Covered85
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $14,529
    Total amount of fees paid to insurance companyUSD $4,650
    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 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 $585,000
    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 number62708000
    Policy instance 3
    Insurance contract or identification number62708000
    Number of Individuals Covered46
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $14,409
    Total amount of fees paid to insurance companyUSD $5,852
    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 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 $599,629
    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 number62708065
    Policy instance 4
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2011-10-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $38
    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 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 $3,606
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00345377
    Policy instance 1
    Insurance contract or identification number00345377
    Number of Individuals Covered109
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $3,209
    Total amount of fees paid to insurance companyUSD $781
    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
    Welfare Benefit Premiums Paid to CarrierUSD $80,665
    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 number67005000
    Policy instance 7
    Insurance contract or identification number67005000
    Number of Individuals Covered48
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $10,721
    Total amount of fees paid to insurance companyUSD $6,247
    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 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 $310,964
    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 number62783000
    Policy instance 6
    Insurance contract or identification number62783000
    Number of Individuals Covered42
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $8,830
    Total amount of fees paid to insurance companyUSD $1,312
    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 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 $358,841
    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 number62708065
    Policy instance 5
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2011-01-01
    Insurance policy end date2011-09-30
    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 BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    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 $9,782
    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 number62708065
    Policy instance 4
    Insurance contract or identification number62708065
    Number of Individuals Covered3
    Insurance policy start date2010-10-01
    Insurance policy end date2010-12-31
    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 BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    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 $4,424
    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 number62708000
    Policy instance 3
    Insurance contract or identification number62708000
    Number of Individuals Covered39
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $13,185
    Total amount of fees paid to insurance companyUSD $5,218
    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 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 $455,885
    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 number863931G
    Policy instance 2
    Insurance contract or identification number863931G
    Number of Individuals Covered131
    Insurance policy start date2009-11-01
    Insurance policy end date2010-10-31
    Total amount of commissions paid to insurance brokerUSD $7,756
    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 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 $49,298
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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