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MENTAL HEALTH ASSOCIATION, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameMENTAL HEALTH ASSOCIATION, INC. GROUP MEDICAL PLAN
Plan identification number 503

MENTAL HEALTH ASSOCIATION, INC. GROUP MEDICAL PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    MENTAL HEALTH ASSOCIATION, INC. has sponsored the creation of one or more 401k plans.

    Company Name:MENTAL HEALTH ASSOCIATION, INC.
    Employer identification number (EIN):046197938
    NAIC Classification:624100
    NAIC Description: Individual and Family Services

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan MENTAL HEALTH ASSOCIATION, INC. GROUP MEDICAL PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5032019-07-01CHERYL CORMIER2021-01-14
    5032018-07-01CHERYL CORMIER2019-12-20
    5032017-07-01
    5032016-07-01
    5032015-07-01
    5032014-07-01JOAN INGERSOLL
    5032013-07-01JOAN INGERSOLL
    5032012-07-01JOAN INGERSOLL
    5032011-07-01CATHERINE BODLEY CATHERINE BODLEY2013-01-24
    5032009-07-01LINDA WILLIAMS
    5032009-07-01LINDA WILLIAMS

    Plan Statistics for MENTAL HEALTH ASSOCIATION, INC. GROUP MEDICAL PLAN

    401k plan membership statisitcs for MENTAL HEALTH ASSOCIATION, INC. GROUP MEDICAL PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-07-01205
    Total number of active participants reported on line 7a of the Form 55002019-07-01265
    Number of retired or separated participants receiving benefits2019-07-010
    Number of other retired or separated participants entitled to future benefits2019-07-010
    Total of all active and inactive participants2019-07-01265
    2018
    Total participants, beginning-of-year2018-07-01204
    Total number of active participants reported on line 7a of the Form 55002018-07-01205
    Number of retired or separated participants receiving benefits2018-07-010
    Number of other retired or separated participants entitled to future benefits2018-07-010
    Total of all active and inactive participants2018-07-01205
    2017
    Total participants, beginning-of-year2017-07-01195
    Total number of active participants reported on line 7a of the Form 55002017-07-01204
    Number of retired or separated participants receiving benefits2017-07-010
    Number of other retired or separated participants entitled to future benefits2017-07-010
    Total of all active and inactive participants2017-07-01204
    2016
    Total participants, beginning-of-year2016-07-01194
    Total number of active participants reported on line 7a of the Form 55002016-07-01195
    Number of retired or separated participants receiving benefits2016-07-010
    Number of other retired or separated participants entitled to future benefits2016-07-010
    Total of all active and inactive participants2016-07-01195
    2015
    Total participants, beginning-of-year2015-07-01174
    Total number of active participants reported on line 7a of the Form 55002015-07-01194
    Number of retired or separated participants receiving benefits2015-07-010
    Number of other retired or separated participants entitled to future benefits2015-07-010
    Total of all active and inactive participants2015-07-01194
    2014
    Total participants, beginning-of-year2014-07-01174
    Total number of active participants reported on line 7a of the Form 55002014-07-01172
    Number of retired or separated participants receiving benefits2014-07-012
    Number of other retired or separated participants entitled to future benefits2014-07-010
    Total of all active and inactive participants2014-07-01174
    2013
    Total participants, beginning-of-year2013-07-01234
    Total number of active participants reported on line 7a of the Form 55002013-07-01174
    Number of retired or separated participants receiving benefits2013-07-010
    Number of other retired or separated participants entitled to future benefits2013-07-010
    Total of all active and inactive participants2013-07-01174
    2012
    Total participants, beginning-of-year2012-07-01204
    Total number of active participants reported on line 7a of the Form 55002012-07-01234
    Number of retired or separated participants receiving benefits2012-07-010
    Number of other retired or separated participants entitled to future benefits2012-07-010
    Total of all active and inactive participants2012-07-01234
    2011
    Total participants, beginning-of-year2011-07-01196
    Total number of active participants reported on line 7a of the Form 55002011-07-01204
    Total of all active and inactive participants2011-07-01204
    Total participants2011-07-01204
    2009
    Total participants, beginning-of-year2009-07-01157
    Total number of active participants reported on line 7a of the Form 55002009-07-01171
    Total of all active and inactive participants2009-07-01171
    Total participants2009-07-01171

    Form 5500 Responses

    2019
    2019-07-01Type of plan entitySingle employer plan
    2019-07-01Submission has been amendedNo
    2019-07-01This submission is the final filingNo
    2019-07-01This return/report is a short plan year return/report (less than 12 months)No
    2019-07-01Plan is a collectively bargained planNo
    2019-07-01Plan funding arrangement – InsuranceYes
    2019-07-01Plan funding arrangement – General assets of the sponsorYes
    2019-07-01Plan benefit arrangement – InsuranceYes
    2019-07-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-07-01Type of plan entitySingle employer plan
    2018-07-01Submission has been amendedNo
    2018-07-01This submission is the final filingNo
    2018-07-01This return/report is a short plan year return/report (less than 12 months)No
    2018-07-01Plan is a collectively bargained planNo
    2018-07-01Plan funding arrangement – InsuranceYes
    2018-07-01Plan funding arrangement – General assets of the sponsorYes
    2018-07-01Plan benefit arrangement – InsuranceYes
    2018-07-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-07-01Type of plan entitySingle employer plan
    2017-07-01Submission has been amendedNo
    2017-07-01This submission is the final filingNo
    2017-07-01This return/report is a short plan year return/report (less than 12 months)No
    2017-07-01Plan is a collectively bargained planNo
    2017-07-01Plan funding arrangement – InsuranceYes
    2017-07-01Plan funding arrangement – General assets of the sponsorYes
    2017-07-01Plan benefit arrangement – InsuranceYes
    2017-07-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-07-01Type of plan entitySingle employer plan
    2016-07-01Submission has been amendedNo
    2016-07-01This submission is the final filingNo
    2016-07-01This return/report is a short plan year return/report (less than 12 months)No
    2016-07-01Plan is a collectively bargained planNo
    2016-07-01Plan funding arrangement – InsuranceYes
    2016-07-01Plan benefit arrangement – InsuranceYes
    2015
    2015-07-01Type of plan entitySingle employer plan
    2015-07-01Submission has been amendedNo
    2015-07-01This submission is the final filingNo
    2015-07-01This return/report is a short plan year return/report (less than 12 months)No
    2015-07-01Plan is a collectively bargained planNo
    2015-07-01Plan funding arrangement – InsuranceYes
    2015-07-01Plan benefit arrangement – InsuranceYes
    2014
    2014-07-01Type of plan entitySingle employer plan
    2014-07-01Submission has been amendedNo
    2014-07-01This submission is the final filingNo
    2014-07-01This return/report is a short plan year return/report (less than 12 months)No
    2014-07-01Plan is a collectively bargained planNo
    2014-07-01Plan funding arrangement – InsuranceYes
    2014-07-01Plan benefit arrangement – InsuranceYes
    2013
    2013-07-01Type of plan entitySingle employer plan
    2013-07-01Submission has been amendedNo
    2013-07-01This submission is the final filingNo
    2013-07-01This return/report is a short plan year return/report (less than 12 months)No
    2013-07-01Plan is a collectively bargained planNo
    2013-07-01Plan funding arrangement – InsuranceYes
    2013-07-01Plan benefit arrangement – InsuranceYes
    2012
    2012-07-01Type of plan entitySingle employer plan
    2012-07-01Submission has been amendedNo
    2012-07-01This submission is the final filingNo
    2012-07-01This return/report is a short plan year return/report (less than 12 months)No
    2012-07-01Plan is a collectively bargained planNo
    2012-07-01Plan funding arrangement – InsuranceYes
    2012-07-01Plan benefit arrangement – InsuranceYes
    2011
    2011-07-01Type of plan entitySingle employer plan
    2011-07-01Submission has been amendedNo
    2011-07-01This submission is the final filingNo
    2011-07-01This return/report is a short plan year return/report (less than 12 months)No
    2011-07-01Plan is a collectively bargained planNo
    2011-07-01Plan funding arrangement – InsuranceYes
    2011-07-01Plan benefit arrangement – InsuranceYes
    2009
    2009-07-01Type of plan entitySingle employer plan
    2009-07-01Submission has been amendedNo
    2009-07-01This submission is the final filingNo
    2009-07-01This return/report is a short plan year return/report (less than 12 months)No
    2009-07-01Plan is a collectively bargained planNo
    2009-07-01Plan funding arrangement – InsuranceYes
    2009-07-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10243903
    Policy instance 3
    Insurance contract or identification number10243903
    Number of Individuals Covered265
    Insurance policy start date2019-07-01
    Insurance policy end date2020-06-30
    Total amount of commissions paid to insurance brokerUSD $1,902
    Total amount of fees paid to insurance companyUSD $597
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $19,170
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,902
    Amount paid for insurance broker fees597
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number55244000/552450
    Policy instance 2
    Insurance contract or identification number55244000/552450
    Number of Individuals Covered160
    Insurance policy start date2019-07-01
    Insurance policy end date2020-06-30
    Total amount of commissions paid to insurance brokerUSD $30,649
    Total amount of fees paid to insurance companyUSD $13,613
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,251,562
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $30,649
    Amount paid for insurance broker fees13613
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00563137
    Policy instance 1
    Insurance contract or identification number00563137
    Number of Individuals Covered150
    Insurance policy start date2019-07-01
    Insurance policy end date2020-06-30
    Total amount of commissions paid to insurance brokerUSD $4,672
    Total amount of fees paid to insurance companyUSD $3,298
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $94,818
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,672
    Amount paid for insurance broker fees3298
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10243904
    Policy instance 4
    Insurance contract or identification number10243904
    Number of Individuals Covered265
    Insurance policy start date2019-07-01
    Insurance policy end date2020-06-30
    Total amount of commissions paid to insurance brokerUSD $3,938
    Total amount of fees paid to insurance companyUSD $1,210
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $38,766
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,938
    Amount paid for insurance broker fees1210
    Additional information about fees paid to insurance brokerBROKER BONUS
    Insurance broker organization code?3
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number49757800/497588
    Policy instance 5
    Insurance contract or identification number49757800/497588
    Number of Individuals Covered13
    Insurance policy start date2019-07-01
    Insurance policy end date2020-06-30
    Total amount of commissions paid to insurance brokerUSD $2,029
    Total amount of fees paid to insurance companyUSD $989
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $94,461
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,029
    Amount paid for insurance broker fees989
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
    Policy contract number756803
    Policy instance 1
    Insurance contract or identification number756803
    Number of Individuals Covered152
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $2,209
    Total amount of fees paid to insurance companyUSD $1,813
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number55244000/552450
    Policy instance 2
    Insurance contract or identification number55244000/552450
    Number of Individuals Covered156
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $39,224
    Total amount of fees paid to insurance companyUSD $6,025
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,084,100
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number49757800
    Policy instance 6
    Insurance contract or identification number49757800
    Number of Individuals Covered6
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $1,646
    Total amount of fees paid to insurance companyUSD $285
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $47,895
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10243904
    Policy instance 5
    Insurance contract or identification number10243904
    Number of Individuals Covered205
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $3,559
    Total amount of fees paid to insurance companyUSD $1,061
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $31,179
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
    Policy contract number756803
    Policy instance 4
    Insurance contract or identification number756803
    Number of Individuals Covered152
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $108
    Total amount of fees paid to insurance companyUSD $210
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10243903
    Policy instance 3
    Insurance contract or identification number10243903
    Number of Individuals Covered205
    Insurance policy start date2018-07-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $1,646
    Total amount of fees paid to insurance companyUSD $523
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $15,402
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number469401
    Policy instance 3
    Insurance contract or identification number469401
    Number of Individuals Covered204
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $5,439
    Total amount of fees paid to insurance companyUSD $407
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits 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 $45,352
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,439
    Amount paid for insurance broker fees407
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameTHE GAUDREAU GROUP INC INS
    HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
    Policy contract number115625
    Policy instance 2
    Insurance contract or identification number115625
    Number of Individuals Covered131
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $41,441
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $41,441
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL NE, LLC
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number000359
    Policy instance 1
    Insurance contract or identification number000359
    Number of Individuals Covered248
    Insurance policy start date2017-07-01
    Insurance policy end date2018-06-30
    Total amount of commissions paid to insurance brokerUSD $3,769
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $106,125
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,769
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL NEW ENGLAND LLC
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number000359
    Policy instance 1
    Insurance contract or identification number000359
    Number of Individuals Covered265
    Insurance policy start date2015-07-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $1,988
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $102,698
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,988
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL NEW ENGLAND LLC
    HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
    Policy contract number115625
    Policy instance 2
    Insurance contract or identification number115625
    Number of Individuals Covered138
    Insurance policy start date2015-07-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $33,235
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $33,235
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL NE, LLC
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number469401
    Policy instance 3
    Insurance contract or identification number469401
    Number of Individuals Covered194
    Insurance policy start date2015-07-01
    Insurance policy end date2016-06-30
    Total amount of commissions paid to insurance brokerUSD $5,457
    Total amount of fees paid to insurance companyUSD $701
    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 $45,817
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,457
    Amount paid for insurance broker fees701
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameTHE GAUDREAU GROUP INC INS
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number000359
    Policy instance 1
    Insurance contract or identification number000359
    Number of Individuals Covered222
    Insurance policy start date2014-07-01
    Insurance policy end date2015-06-30
    Total amount of commissions paid to insurance brokerUSD $2,255
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $100,277
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,554
    Insurance broker organization code?3
    Insurance broker nameHUB INTERNATIONAL NEW ENGLAND LLC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10160205
    Policy instance 4
    Insurance contract or identification number10160205
    Number of Individuals Covered172
    Insurance policy start date2014-07-01
    Insurance policy end date2015-06-30
    Total amount of commissions paid to insurance brokerUSD $869
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 $7,398
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $869
    Insurance broker organization code?3
    Insurance broker nameHABERMAN INS GRP INC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10160206
    Policy instance 3
    Insurance contract or identification number10160206
    Number of Individuals Covered173
    Insurance policy start date2014-07-01
    Insurance policy end date2015-06-30
    Total amount of commissions paid to insurance brokerUSD $2,740
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $23,627
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,740
    Insurance broker organization code?3
    Insurance broker nameHABERMAN INS GRP INC
    HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
    Policy contract number115625
    Policy instance 2
    Insurance contract or identification number115625
    Number of Individuals Covered124
    Insurance policy start date2014-07-01
    Insurance policy end date2015-06-30
    Total amount of commissions paid to insurance brokerUSD $36,195
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $36,195
    Insurance broker organization code?3
    Insurance broker nameFIELD EDDY, INC.
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number000359
    Policy instance 1
    Insurance contract or identification number000359
    Number of Individuals Covered231
    Insurance policy start date2013-07-01
    Insurance policy end date2014-06-30
    Total amount of commissions paid to insurance brokerUSD $3,422
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    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 $3,422
    Insurance broker organization code?3
    Insurance broker nameFEILD EDDY, INC.
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10160206
    Policy instance 3
    Insurance contract or identification number10160206
    Number of Individuals Covered181
    Insurance policy start date2013-07-01
    Insurance policy end date2014-06-30
    Total amount of commissions paid to insurance brokerUSD $3,434
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $27,405
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,434
    Insurance broker organization code?3
    Insurance broker nameHABERMAN INS GRP INC
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10160205
    Policy instance 4
    Insurance contract or identification number10160205
    Number of Individuals Covered181
    Insurance policy start date2013-07-01
    Insurance policy end date2014-06-30
    Total amount of commissions paid to insurance brokerUSD $1,057
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 $8,581
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,057
    Insurance broker organization code?3
    Insurance broker nameHABERMAN INS GRP INC
    HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
    Policy contract number115625
    Policy instance 2
    Insurance contract or identification number115625
    Number of Individuals Covered114
    Insurance policy start date2013-07-01
    Insurance policy end date2014-06-30
    Total amount of commissions paid to insurance brokerUSD $35,130
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $35,130
    Insurance broker organization code?3
    Insurance broker nameFIELD EDDY, INC.
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10160205
    Policy instance 1
    Insurance contract or identification number10160205
    Number of Individuals Covered174
    Insurance policy start date2012-07-01
    Insurance policy end date2013-06-30
    Total amount of commissions paid to insurance brokerUSD $971
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    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 $7,827
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
    Policy contract number115625
    Policy instance 2
    Insurance contract or identification number115625
    Number of Individuals Covered112
    Insurance policy start date2012-07-01
    Insurance policy end date2013-06-30
    Total amount of commissions paid to insurance brokerUSD $38,023
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $38,023
    Insurance broker organization code?3
    Insurance broker nameFIELD EDDY, INC.
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number000359
    Policy instance 1
    Insurance contract or identification number000359
    Number of Individuals Covered234
    Insurance policy start date2012-07-01
    Insurance policy end date2013-06-30
    Total amount of commissions paid to insurance brokerUSD $3,731
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,731
    Insurance broker organization code?3
    Insurance broker nameFEILD EDDY, INC.
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number10160206
    Policy instance 2
    Insurance contract or identification number10160206
    Number of Individuals Covered174
    Insurance policy start date2012-07-01
    Insurance policy end date2013-06-30
    Total amount of commissions paid to insurance brokerUSD $3,194
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $24,546
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
    Policy contract numberE7859879
    Policy instance 2
    Insurance contract or identification numberE7859879
    Number of Individuals Covered46
    Insurance policy start date2011-07-01
    Insurance policy end date2012-06-30
    Total amount of commissions paid to insurance brokerUSD $4,151
    Total amount of fees paid to insurance companyUSD $642
    Other welfare benefits providedCANCER, HOSPITAL, LIFE, ACCIDENT
    Welfare Benefit Premiums Paid to CarrierUSD $26,026
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00448610
    Policy instance 1
    Insurance contract or identification number00448610
    Number of Individuals Covered170
    Insurance policy start date2011-07-01
    Insurance policy end date2012-06-30
    Total amount of commissions paid to insurance brokerUSD $4,750
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $35,248
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
    Policy contract number115625
    Policy instance 1
    Insurance contract or identification number115625
    Number of Individuals Covered116
    Insurance policy start date2010-07-01
    Insurance policy end date2011-06-30
    Total amount of commissions paid to insurance brokerUSD $36,028
    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 number000359
    Policy instance 2
    Insurance contract or identification number000359
    Number of Individuals Covered223
    Insurance policy start date2010-07-01
    Insurance policy end date2011-06-30
    Total amount of commissions paid to insurance brokerUSD $3,475
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $80,213
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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