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COMMUNITY CONNECTION, INC. HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan NameCOMMUNITY CONNECTION, INC. HEALTH AND WELFARE BENEFITS PLAN
Plan identification number 501

COMMUNITY CONNECTION, INC. HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    COMMUNITY CONNECTIONS, INC. has sponsored the creation of one or more 401k plans.

    Company Name:COMMUNITY CONNECTIONS, INC.
    Employer identification number (EIN):042871024
    NAIC Classification:624100
    NAIC Description: Individual and Family Services

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan COMMUNITY CONNECTION, INC. HEALTH AND WELFARE BENEFITS PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-01-01PATRICIA PATTEN2020-06-16
    5012018-01-01PATRICIA J. PATTEN2019-09-16
    5012017-01-01
    5012016-01-01PATRICIA J PATTEN
    5012015-01-01PATRICIA J PATTEN
    5012014-01-01PATRICIA J PATTEN
    5012013-01-01PATRICIA J PATTEN
    5012012-12-25PATRICIA PATTEN
    5012011-12-25PATRICIA PATTEN
    5012009-01-01PATRICIA PATTEN
    5012009-01-01SUE REARDON
    5012008-01-01PATRICIA PATTEN
    5012007-01-01PATRICIA PATTEN
    5012006-01-01PATRICIA PATTEN
    5012005-01-01PATRICIA PATTEN
    5012004-01-01PATRICIA PATTEN
    5012003-01-01PATRICIA PATTEN

    Plan Statistics for COMMUNITY CONNECTION, INC. HEALTH AND WELFARE BENEFITS PLAN

    401k plan membership statisitcs for COMMUNITY CONNECTION, INC. HEALTH AND WELFARE BENEFITS PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-01-01224
    Total number of active participants reported on line 7a of the Form 55002019-01-01225
    Number of retired or separated participants receiving benefits2019-01-010
    Number of other retired or separated participants entitled to future benefits2019-01-010
    Total of all active and inactive participants2019-01-01225
    Number of employers contributing to the scheme2019-01-010
    2018
    Total participants, beginning-of-year2018-01-01234
    Total number of active participants reported on line 7a of the Form 55002018-01-01224
    Number of retired or separated participants receiving benefits2018-01-010
    Number of other retired or separated participants entitled to future benefits2018-01-010
    Total of all active and inactive participants2018-01-01224
    Number of employers contributing to the scheme2018-01-010
    2017
    Total participants, beginning-of-year2017-01-01232
    Total number of active participants reported on line 7a of the Form 55002017-01-01234
    Number of retired or separated participants receiving benefits2017-01-010
    Number of other retired or separated participants entitled to future benefits2017-01-010
    Total of all active and inactive participants2017-01-01234
    2016
    Total participants, beginning-of-year2016-01-01228
    Total number of active participants reported on line 7a of the Form 55002016-01-01226
    Number of retired or separated participants receiving benefits2016-01-016
    Number of other retired or separated participants entitled to future benefits2016-01-010
    Total of all active and inactive participants2016-01-01232
    2015
    Total participants, beginning-of-year2015-01-01280
    Total number of active participants reported on line 7a of the Form 55002015-01-01228
    Number of retired or separated participants receiving benefits2015-01-010
    Number of other retired or separated participants entitled to future benefits2015-01-010
    Total of all active and inactive participants2015-01-01228
    2014
    Total participants, beginning-of-year2014-01-01191
    Total number of active participants reported on line 7a of the Form 55002014-01-01280
    Number of retired or separated participants receiving benefits2014-01-010
    Number of other retired or separated participants entitled to future benefits2014-01-010
    Total of all active and inactive participants2014-01-01280
    2013
    Total participants, beginning-of-year2013-01-0199
    Total number of active participants reported on line 7a of the Form 55002013-01-01191
    Number of retired or separated participants receiving benefits2013-01-010
    Number of other retired or separated participants entitled to future benefits2013-01-010
    Total of all active and inactive participants2013-01-01191
    2012
    Total participants, beginning-of-year2012-12-25101
    Total number of active participants reported on line 7a of the Form 55002012-12-2599
    Number of retired or separated participants receiving benefits2012-12-250
    Number of other retired or separated participants entitled to future benefits2012-12-250
    Total of all active and inactive participants2012-12-2599
    2011
    Total participants, beginning-of-year2011-12-25101
    Total number of active participants reported on line 7a of the Form 55002011-12-25101
    Number of retired or separated participants receiving benefits2011-12-250
    Number of other retired or separated participants entitled to future benefits2011-12-250
    Total of all active and inactive participants2011-12-25101
    2009
    Total participants, beginning-of-year2009-01-01105
    Total number of active participants reported on line 7a of the Form 55002009-01-01110
    Number of retired or separated participants receiving benefits2009-01-010
    Number of other retired or separated participants entitled to future benefits2009-01-010
    Total of all active and inactive participants2009-01-01110
    Total participants2009-01-01110
    2008
    Total participants, beginning-of-year2008-01-01148
    Total number of active participants reported on line 7a of the Form 55002008-01-01131
    Number of retired or separated participants receiving benefits2008-01-010
    Number of other retired or separated participants entitled to future benefits2008-01-010
    Total of all active and inactive participants2008-01-01131
    2007
    Total participants, beginning-of-year2007-01-01187
    Total number of active participants reported on line 7a of the Form 55002007-01-01148
    Number of retired or separated participants receiving benefits2007-01-010
    Number of other retired or separated participants entitled to future benefits2007-01-010
    Total of all active and inactive participants2007-01-01148
    2006
    Total participants, beginning-of-year2006-01-01187
    Total number of active participants reported on line 7a of the Form 55002006-01-01187
    Number of retired or separated participants receiving benefits2006-01-010
    Number of other retired or separated participants entitled to future benefits2006-01-010
    Total of all active and inactive participants2006-01-01187
    2005
    Total participants, beginning-of-year2005-01-01187
    Total number of active participants reported on line 7a of the Form 55002005-01-01187
    Number of retired or separated participants receiving benefits2005-01-010
    Number of other retired or separated participants entitled to future benefits2005-01-010
    Total of all active and inactive participants2005-01-01187
    2004
    Total participants, beginning-of-year2004-01-01100
    Total number of active participants reported on line 7a of the Form 55002004-01-01187
    Number of retired or separated participants receiving benefits2004-01-010
    Number of other retired or separated participants entitled to future benefits2004-01-010
    Total of all active and inactive participants2004-01-01187
    2003
    Total participants, beginning-of-year2003-01-01100
    Total number of active participants reported on line 7a of the Form 55002003-01-01100
    Number of retired or separated participants receiving benefits2003-01-010
    Number of other retired or separated participants entitled to future benefits2003-01-010
    Total of all active and inactive participants2003-01-01100

    Form 5500 Responses

    2019
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan funding arrangement – General assets of the sponsorYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-01-01Type of plan entitySingle employer plan
    2018-01-01Plan funding arrangement – InsuranceYes
    2018-01-01Plan funding arrangement – General assets of the sponsorYes
    2018-01-01Plan benefit arrangement – InsuranceYes
    2018-01-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan funding arrangement – General assets of the sponsorYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Submission has been amendedNo
    2016-01-01This submission is the final filingNo
    2016-01-01This return/report is a short plan year return/report (less than 12 months)No
    2016-01-01Plan is a collectively bargained planNo
    2016-01-01Plan funding arrangement – InsuranceYes
    2016-01-01Plan funding arrangement – General assets of the sponsorYes
    2016-01-01Plan benefit arrangement – InsuranceYes
    2016-01-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01Submission has been amendedNo
    2015-01-01This submission is the final filingNo
    2015-01-01This return/report is a short plan year return/report (less than 12 months)No
    2015-01-01Plan is a collectively bargained planNo
    2015-01-01Plan funding arrangement – InsuranceYes
    2015-01-01Plan funding arrangement – General assets of the sponsorYes
    2015-01-01Plan benefit arrangement – InsuranceYes
    2015-01-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-01-01Type of plan entitySingle employer plan
    2014-01-01Submission has been amendedNo
    2014-01-01This submission is the final filingNo
    2014-01-01This return/report is a short plan year return/report (less than 12 months)No
    2014-01-01Plan is a collectively bargained planNo
    2014-01-01Plan funding arrangement – InsuranceYes
    2014-01-01Plan benefit arrangement – InsuranceYes
    2013
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Submission has been amendedNo
    2013-01-01This submission is the final filingNo
    2013-01-01This return/report is a short plan year return/report (less than 12 months)No
    2013-01-01Plan is a collectively bargained planNo
    2013-01-01Plan funding arrangement – InsuranceYes
    2013-01-01Plan benefit arrangement – InsuranceYes
    2012
    2012-12-25Type of plan entitySingle employer plan
    2012-12-25Submission has been amendedNo
    2012-12-25This submission is the final filingNo
    2012-12-25This return/report is a short plan year return/report (less than 12 months)Yes
    2012-12-25Plan is a collectively bargained planNo
    2012-12-25Plan funding arrangement – InsuranceYes
    2012-12-25Plan benefit arrangement – InsuranceYes
    2011
    2011-12-25Type of plan entitySingle employer plan
    2011-12-25Submission has been amendedNo
    2011-12-25This submission is the final filingNo
    2011-12-25This return/report is a short plan year return/report (less than 12 months)No
    2011-12-25Plan is a collectively bargained planNo
    2011-12-25Plan funding arrangement – InsuranceYes
    2011-12-25Plan benefit arrangement – InsuranceYes
    2009
    2009-01-01Type of plan entitySingle employer plan
    2009-01-01Submission has been amendedYes
    2009-01-01This submission is the final filingNo
    2009-01-01This return/report is a short plan year return/report (less than 12 months)No
    2009-01-01Plan is a collectively bargained planNo
    2009-01-01Plan funding arrangement – InsuranceYes
    2009-01-01Plan benefit arrangement – InsuranceYes
    2008
    2008-01-01Type of plan entitySingle employer plan
    2008-01-01Submission has been amendedNo
    2008-01-01This submission is the final filingNo
    2008-01-01This return/report is a short plan year return/report (less than 12 months)No
    2008-01-01Plan is a collectively bargained planNo
    2008-01-01Plan funding arrangement – InsuranceYes
    2008-01-01Plan benefit arrangement – InsuranceYes
    2007
    2007-01-01Type of plan entitySingle employer plan
    2007-01-01Submission has been amendedNo
    2007-01-01This submission is the final filingNo
    2007-01-01This return/report is a short plan year return/report (less than 12 months)No
    2007-01-01Plan is a collectively bargained planNo
    2007-01-01Plan funding arrangement – InsuranceYes
    2007-01-01Plan benefit arrangement – InsuranceYes
    2006
    2006-01-01Type of plan entitySingle employer plan
    2006-01-01Submission has been amendedNo
    2006-01-01This submission is the final filingNo
    2006-01-01This return/report is a short plan year return/report (less than 12 months)No
    2006-01-01Plan is a collectively bargained planNo
    2006-01-01Plan funding arrangement – InsuranceYes
    2006-01-01Plan benefit arrangement – InsuranceYes
    2005
    2005-01-01Type of plan entitySingle employer plan
    2005-01-01Submission has been amendedNo
    2005-01-01This submission is the final filingNo
    2005-01-01This return/report is a short plan year return/report (less than 12 months)No
    2005-01-01Plan is a collectively bargained planNo
    2005-01-01Plan funding arrangement – InsuranceYes
    2005-01-01Plan benefit arrangement – InsuranceYes
    2004
    2004-01-01Type of plan entitySingle employer plan
    2004-01-01Submission has been amendedNo
    2004-01-01This submission is the final filingNo
    2004-01-01This return/report is a short plan year return/report (less than 12 months)No
    2004-01-01Plan is a collectively bargained planNo
    2004-01-01Plan funding arrangement – InsuranceYes
    2004-01-01Plan benefit arrangement – InsuranceYes
    2003
    2003-01-01Type of plan entitySingle employer plan
    2003-01-01First time form 5500 has been submittedYes
    2003-01-01Submission has been amendedNo
    2003-01-01This submission is the final filingNo
    2003-01-01This return/report is a short plan year return/report (less than 12 months)No
    2003-01-01Plan is a collectively bargained planNo
    2003-01-01Plan funding arrangement – InsuranceYes
    2003-01-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number877364G
    Policy instance 2
    Insurance contract or identification number877364G
    Number of Individuals Covered225
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $9,081
    Total amount of fees paid to insurance companyUSD $8,140
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $108,631
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,081
    Amount paid for insurance broker fees531
    Additional information about fees paid to insurance brokerBONUS
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4958791
    Policy instance 1
    Insurance contract or identification number4958791
    Number of Individuals Covered192
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $33,582
    Total amount of fees paid to insurance companyUSD $1,590
    Health Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $33,582
    Amount paid for insurance broker fees1590
    Additional information about fees paid to insurance brokerOTHER COMMISSION
    Insurance broker organization code?3
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number877364G
    Policy instance 2
    Insurance contract or identification number877364G
    Number of Individuals Covered224
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $9,008
    Total amount of fees paid to insurance companyUSD $3,283
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $106,258
    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 number4958791
    Policy instance 1
    Insurance contract or identification number4958791
    Number of Individuals Covered173
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $36,593
    Total amount of fees paid to insurance companyUSD $9,025
    Health Insurance Welfare BenefitYes
    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 number130920095933
    Policy instance 1
    Insurance contract or identification number130920095933
    Number of Individuals Covered184
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $33,871
    Total amount of fees paid to insurance companyUSD $9,400
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,406,610
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $31,431
    Amount paid for insurance broker fees9400
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC.
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number877364G
    Policy instance 2
    Insurance contract or identification number877364G
    Number of Individuals Covered234
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $8,621
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Welfare Benefit Premiums Paid to CarrierUSD $111,142
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,547
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameROGERS AND GRAY INSURANCE AGENCY
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number395828
    Policy instance 2
    Insurance contract or identification number395828
    Number of Individuals Covered228
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $9,573
    Total amount of fees paid to insurance companyUSD $998
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $122,212
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,573
    Amount paid for insurance broker fees998
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number130920095933
    Policy instance 1
    Insurance contract or identification number130920095933
    Number of Individuals Covered157
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $31,670
    Total amount of fees paid to insurance companyUSD $13,358
    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 $1,146,380
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $31,670
    Amount paid for insurance broker fees13358
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0ACZD
    Policy instance 3
    Insurance contract or identification numberGLUG0ACZD
    Number of Individuals Covered182
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $5,648
    Total amount of fees paid to insurance companyUSD $2,072
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $62,830
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,648
    Amount paid for insurance broker fees2072
    Additional information about fees paid to insurance brokerSERVICE FEES
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number395828
    Policy instance 2
    Insurance contract or identification number395828
    Number of Individuals Covered280
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $9,263
    Total amount of fees paid to insurance companyUSD $1,588
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $113,882
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,263
    Amount paid for insurance broker fees1588
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number42674079
    Policy instance 1
    Insurance contract or identification number42674079
    Number of Individuals Covered156
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $33,680
    Total amount of fees paid to insurance companyUSD $813
    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 $1,068,668
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $33,680
    Amount paid for insurance broker fees813
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberGLUG0ACZD
    Policy instance 3
    Insurance contract or identification numberGLUG0ACZD
    Number of Individuals Covered191
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $5,696
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $63,571
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,696
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract numberR0376343
    Policy instance 2
    Insurance contract or identification numberR0376343
    Number of Individuals Covered4
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $736
    Total amount of fees paid to insurance companyUSD $91
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $6,033
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $736
    Amount paid for insurance broker fees91
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL INS. SVCS., INC
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered164
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $30,211
    Total amount of fees paid to insurance companyUSD $8,010
    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 $1,308,527
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $14,186
    Amount paid for insurance broker fees8010
    Additional information about fees paid to insurance brokerBONUS AND PERSISTENCY COMMISSIONS
    Insurance broker organization code?3
    Insurance broker nameSTARKWEATHER AND SHEPLEY INSURANCE
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered170
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $29,721
    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?Yes
    Commission paid to Insurance BrokerUSD $27,006
    Insurance broker organization code?3
    Insurance broker nameSTARKWEATHER AND SHEPLEY INSURANCE
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered101
    Insurance policy start date2011-12-25
    Insurance policy end date2011-12-31
    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 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?Yes
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered101
    Insurance policy start date2010-12-25
    Insurance policy end date2011-12-24
    Total amount of commissions paid to insurance brokerUSD $30,648
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,365,947
    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 number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered110
    Insurance policy start date2009-12-25
    Insurance policy end date2010-12-24
    Total amount of commissions paid to insurance brokerUSD $25,925
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,299,695
    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 number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered231
    Insurance policy start date2008-01-01
    Insurance policy end date2008-12-31
    Total amount of commissions paid to insurance brokerUSD $25,942
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,293,980
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $25,942
    Insurance broker organization code?3
    Insurance broker nameINSURANCE PROFESSIONALS OF NE, INC.
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered148
    Insurance policy start date2007-01-01
    Insurance policy end date2007-12-31
    Total amount of commissions paid to insurance brokerUSD $16,504
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,106,543
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $16,504
    Insurance broker organization code?3
    Insurance broker nameINSURANCE PROFESSIONALS OF NE, INC.
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 2
    Insurance contract or identification number4954646
    Number of Individuals Covered187
    Insurance policy start date2005-12-25
    Insurance policy end date2006-12-24
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered187
    Insurance policy start date2006-12-25
    Insurance policy end date2006-12-31
    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 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?Yes
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4954646
    Policy instance 1
    Insurance contract or identification number4954646
    Number of Individuals Covered187
    Insurance policy start date2004-12-25
    Insurance policy end date2005-12-24
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
    Policy contract number66454
    Policy instance 1
    Insurance contract or identification number66454
    Number of Individuals Covered187
    Insurance policy start date2003-12-25
    Insurance policy end date2004-12-24
    Total amount of commissions paid to insurance brokerUSD $20,054
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $701,516
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $20,054
    Insurance broker organization code?3
    Insurance broker nameINSURANCE PROFESSIONALS OF NE, INC.
    HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
    Policy contract number66454
    Policy instance 1
    Insurance contract or identification number66454
    Number of Individuals Covered100
    Insurance policy start date2002-12-25
    Insurance policy end date2003-12-24
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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