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BY APPOINTMENT ONLY HEALTH & WELFARE PLAN 401k Plan overview

Plan NameBY APPOINTMENT ONLY HEALTH & WELFARE PLAN
Plan identification number 501

BY APPOINTMENT ONLY HEALTH & WELFARE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    BY APPOINTMENT ONLY has sponsored the creation of one or more 401k plans.

    Company Name:BY APPOINTMENT ONLY
    Employer identification number (EIN):043462585
    NAIC Classification:561420

    Additional information about BY APPOINTMENT ONLY

    Jurisdiction of Incorporation: Nevada Department of State
    Incorporation Date: 1996-03-11
    Company Identification Number: 19961093533

    More information about BY APPOINTMENT ONLY

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan BY APPOINTMENT ONLY HEALTH & WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012019-02-01
    5012018-02-01
    5012017-02-01LINDA METZGER
    5012016-02-01LINDA METZGER
    5012015-02-01LINDA METZGER
    5012014-02-01LINDA METZGER
    5012013-02-01LINDA METZGER
    5012012-02-01LINDA METZGER
    5012011-02-01LINDA METZGER
    5012010-02-01LINDA METZGER
    5012009-02-01LINDA METZGER

    Plan Statistics for BY APPOINTMENT ONLY HEALTH & WELFARE PLAN

    401k plan membership statisitcs for BY APPOINTMENT ONLY HEALTH & WELFARE PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-02-01172
    Total number of active participants reported on line 7a of the Form 55002019-02-01174
    Number of retired or separated participants receiving benefits2019-02-013
    Number of other retired or separated participants entitled to future benefits2019-02-0110
    Total of all active and inactive participants2019-02-01187
    2018
    Total participants, beginning-of-year2018-02-01201
    Total number of active participants reported on line 7a of the Form 55002018-02-01156
    Number of retired or separated participants receiving benefits2018-02-013
    Number of other retired or separated participants entitled to future benefits2018-02-0113
    Total of all active and inactive participants2018-02-01172
    2017
    Total participants, beginning-of-year2017-02-01187
    Total number of active participants reported on line 7a of the Form 55002017-02-01179
    Number of retired or separated participants receiving benefits2017-02-011
    Number of other retired or separated participants entitled to future benefits2017-02-0121
    Total of all active and inactive participants2017-02-01201
    Total participants2017-02-01201
    2016
    Total participants, beginning-of-year2016-02-01223
    Total number of active participants reported on line 7a of the Form 55002016-02-01180
    Number of retired or separated participants receiving benefits2016-02-013
    Number of other retired or separated participants entitled to future benefits2016-02-014
    Total of all active and inactive participants2016-02-01187
    Total participants2016-02-01187
    2015
    Total participants, beginning-of-year2015-02-01234
    Total number of active participants reported on line 7a of the Form 55002015-02-01199
    Number of retired or separated participants receiving benefits2015-02-017
    Number of other retired or separated participants entitled to future benefits2015-02-0117
    Total of all active and inactive participants2015-02-01223
    Total participants2015-02-01223
    2014
    Total participants, beginning-of-year2014-02-01239
    Total number of active participants reported on line 7a of the Form 55002014-02-01229
    Number of retired or separated participants receiving benefits2014-02-015
    Number of other retired or separated participants entitled to future benefits2014-02-010
    Total of all active and inactive participants2014-02-01234
    Total participants2014-02-01234
    2013
    Total participants, beginning-of-year2013-02-01158
    Total number of active participants reported on line 7a of the Form 55002013-02-01225
    Number of retired or separated participants receiving benefits2013-02-017
    Number of other retired or separated participants entitled to future benefits2013-02-017
    Total of all active and inactive participants2013-02-01239
    Total participants2013-02-01239
    2012
    Total participants, beginning-of-year2012-02-01192
    Total number of active participants reported on line 7a of the Form 55002012-02-01150
    Number of retired or separated participants receiving benefits2012-02-011
    Number of other retired or separated participants entitled to future benefits2012-02-017
    Total of all active and inactive participants2012-02-01158
    Total participants2012-02-01158
    2011
    Total participants, beginning-of-year2011-02-01207
    Total number of active participants reported on line 7a of the Form 55002011-02-01172
    Number of retired or separated participants receiving benefits2011-02-012
    Number of other retired or separated participants entitled to future benefits2011-02-0118
    Total of all active and inactive participants2011-02-01192
    Total participants2011-02-01192
    2010
    Total participants, beginning-of-year2010-02-01196
    Total number of active participants reported on line 7a of the Form 55002010-02-01178
    Number of retired or separated participants receiving benefits2010-02-017
    Number of other retired or separated participants entitled to future benefits2010-02-0122
    Total of all active and inactive participants2010-02-01207
    Total participants2010-02-01207
    2009
    Total participants, beginning-of-year2009-02-01199
    Total number of active participants reported on line 7a of the Form 55002009-02-01186
    Number of retired or separated participants receiving benefits2009-02-016
    Number of other retired or separated participants entitled to future benefits2009-02-014
    Total of all active and inactive participants2009-02-01196
    Total participants2009-02-01196

    Form 5500 Responses

    2019
    2019-02-01Type of plan entitySingle employer plan
    2019-02-01Plan funding arrangement – InsuranceYes
    2019-02-01Plan benefit arrangement – InsuranceYes
    2018
    2018-02-01Type of plan entitySingle employer plan
    2018-02-01Plan funding arrangement – InsuranceYes
    2018-02-01Plan benefit arrangement – InsuranceYes
    2017
    2017-02-01Type of plan entitySingle employer plan
    2017-02-01Plan funding arrangement – InsuranceYes
    2017-02-01Plan benefit arrangement – InsuranceYes
    2016
    2016-02-01Type of plan entitySingle employer plan
    2016-02-01Plan funding arrangement – InsuranceYes
    2016-02-01Plan benefit arrangement – InsuranceYes
    2015
    2015-02-01Type of plan entitySingle employer plan
    2015-02-01Plan funding arrangement – InsuranceYes
    2015-02-01Plan benefit arrangement – InsuranceYes
    2014
    2014-02-01Type of plan entitySingle employer plan
    2014-02-01Plan funding arrangement – InsuranceYes
    2014-02-01Plan benefit arrangement – InsuranceYes
    2013
    2013-02-01Type of plan entitySingle employer plan
    2013-02-01Plan funding arrangement – InsuranceYes
    2013-02-01Plan benefit arrangement – InsuranceYes
    2012
    2012-02-01Type of plan entitySingle employer plan
    2012-02-01Plan funding arrangement – InsuranceYes
    2012-02-01Plan benefit arrangement – InsuranceYes
    2011
    2011-02-01Type of plan entitySingle employer plan
    2011-02-01Plan funding arrangement – InsuranceYes
    2011-02-01Plan benefit arrangement – InsuranceYes
    2010
    2010-02-01Type of plan entitySingle employer plan
    2010-02-01Plan funding arrangement – InsuranceYes
    2010-02-01Plan benefit arrangement – InsuranceYes
    2009
    2009-02-01Type of plan entitySingle employer plan
    2009-02-01Plan funding arrangement – InsuranceYes
    2009-02-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered226
    Insurance policy start date2019-02-01
    Insurance policy end date2020-01-31
    Total amount of commissions paid to insurance brokerUSD $4,641
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $118,904
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,641
    Insurance broker organization code?3
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number120109083542
    Policy instance 5
    Insurance contract or identification number120109083542
    Number of Individuals Covered134
    Insurance policy start date2019-02-01
    Insurance policy end date2020-01-31
    Total amount of commissions paid to insurance brokerUSD $32,592
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,053,645
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $32,592
    Insurance broker organization code?3
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
    Policy contract number12256034
    Policy instance 2
    Insurance contract or identification number12256034
    Number of Individuals Covered82
    Insurance policy start date2019-02-01
    Insurance policy end date2020-01-31
    Total amount of commissions paid to insurance brokerUSD $114
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $13,543
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $114
    Insurance broker organization code?3
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 3
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered174
    Insurance policy start date2019-02-01
    Insurance policy end date2020-01-31
    Total amount of commissions paid to insurance brokerUSD $10,226
    Total amount of fees paid to insurance companyUSD $5,881
    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 $82,726
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,226
    Amount paid for insurance broker fees5881
    Insurance broker organization code?3
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number120109083542
    Policy instance 4
    Insurance contract or identification number120109083542
    Number of Individuals Covered72
    Insurance policy start date2019-02-01
    Insurance policy end date2020-01-31
    Total amount of commissions paid to insurance brokerUSD $14,940
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $588,073
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,940
    Insurance broker organization code?3
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number45785000/6000
    Policy instance 4
    Insurance contract or identification number45785000/6000
    Number of Individuals Covered70
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $9,475
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $472,594
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 3
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered156
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $10,044
    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 $82,545
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
    Policy contract number12256034
    Policy instance 2
    Insurance contract or identification number12256034
    Number of Individuals Covered79
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $904
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $14,323
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered223
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $4,681
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $119,459
    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 number79372000
    Policy instance 5
    Insurance contract or identification number79372000
    Number of Individuals Covered150
    Insurance policy start date2018-02-01
    Insurance policy end date2019-01-31
    Total amount of commissions paid to insurance brokerUSD $20,249
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $993,974
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered261
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $4,906
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $130,242
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,906
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number45785000/6000
    Policy instance 4
    Insurance contract or identification number45785000/6000
    Number of Individuals Covered72
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $10,254
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $506,712
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,254
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 3
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered179
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $13,579
    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 $93,919
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,579
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
    Policy contract number12256034
    Policy instance 2
    Insurance contract or identification number12256034
    Number of Individuals Covered89
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $958
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $15,862
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $958
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number79372000
    Policy instance 5
    Insurance contract or identification number79372000
    Number of Individuals Covered160
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $20,296
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $993,581
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $20,296
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number79372000
    Policy instance 5
    Insurance contract or identification number79372000
    Number of Individuals Covered181
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $21,442
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,088,268
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $21,442
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45785000/6000
    Policy instance 4
    Insurance contract or identification number45785000/6000
    Number of Individuals Covered92
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $9,797
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $520,457
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,797
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered288
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $4,828
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $137,680
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,828
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12256034
    Policy instance 2
    Insurance contract or identification number12256034
    Number of Individuals Covered102
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $1,036
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $18,037
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,036
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 3
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered199
    Insurance policy start date2015-02-01
    Insurance policy end date2016-01-31
    Total amount of commissions paid to insurance brokerUSD $12,321
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $106,240
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,321
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number79372000
    Policy instance 5
    Insurance contract or identification number79372000
    Number of Individuals Covered181
    Total amount of commissions paid to insurance brokerUSD $22,980
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,088,268
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $22,980
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45785000/6000
    Policy instance 4
    Insurance contract or identification number45785000/6000
    Number of Individuals Covered92
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $10,432
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $520,457
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,432
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 3
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered229
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $8,918
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $84,879
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,918
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12256034
    Policy instance 2
    Insurance contract or identification number12256034
    Number of Individuals Covered91
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $977
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $16,372
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $977
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered321
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $5,076
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $139,258
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,076
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered317
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $5,025
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $134,688
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,025
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12256034
    Policy instance 2
    Insurance contract or identification number12256034
    Number of Individuals Covered97
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $919
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $14,756
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $919
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 3
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered225
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $11,587
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $95,822
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,587
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45785000
    Policy instance 4
    Insurance contract or identification number45785000
    Number of Individuals Covered19
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $4,554
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $189,993
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,217
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45786000
    Policy instance 6
    Insurance contract or identification number45786000
    Number of Individuals Covered27
    Total amount of commissions paid to insurance brokerUSD $5,908
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $252,945
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,589
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number79372000
    Policy instance 5
    Insurance contract or identification number79372000
    Number of Individuals Covered111
    Total amount of commissions paid to insurance brokerUSD $26,762
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,087,161
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $25,126
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45786000
    Policy instance 2
    Insurance contract or identification number45786000
    Number of Individuals Covered17
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $4,304
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $188,173
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,304
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12256034
    Policy instance 3
    Insurance contract or identification number12256034
    Number of Individuals Covered74
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $843
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $12,607
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $843
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 4
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered150
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $10,400
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $84,683
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,400
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number45785000
    Policy instance 5
    Insurance contract or identification number45785000
    Number of Individuals Covered14
    Total amount of commissions paid to insurance brokerUSD $4,934
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $196,121
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,934
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered258
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $4,514
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $111,224
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,514
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number79372000
    Policy instance 6
    Insurance contract or identification number79372000
    Number of Individuals Covered86
    Total amount of commissions paid to insurance brokerUSD $23,059
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $948,338
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $23,059
    Insurance broker organization code?3
    Insurance broker nameELIOT LAPPEN INSURANCE AGENCY
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number4955493
    Policy instance 2
    Insurance contract or identification number4955493
    Number of Individuals Covered127
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $33,456
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered265
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $4,723
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $121,773
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12256034
    Policy instance 3
    Insurance contract or identification number12256034
    Number of Individuals Covered85
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $925
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $14,926
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 4
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered172
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $13,253
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $87,943
    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 number4955493
    Policy instance 2
    Insurance contract or identification number4955493
    Number of Individuals Covered146
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $43,529
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,425,026
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $41,390
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12256034
    Policy instance 3
    Insurance contract or identification number12256034
    Number of Individuals Covered98
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $1,046
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $18,318
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,046
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000AFBY
    Policy instance 4
    Insurance contract or identification numberG000AFBY
    Number of Individuals Covered178
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $1,305
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $92,354
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,305
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number003985
    Policy instance 1
    Insurance contract or identification number003985
    Number of Individuals Covered298
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $4,997
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $139,148
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,997
    Insurance broker organization code?3
    Insurance broker nameSUMMIT FINANCIAL INSURANCE AGENCY

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