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PEOPLESBANK 125 PREMIUM CONVERSION PLAN 401k Plan overview

Plan NamePEOPLESBANK 125 PREMIUM CONVERSION PLAN
Plan identification number 502

PEOPLESBANK 125 PREMIUM CONVERSION PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

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

    Company Name:PEOPLESBANK
    Employer identification number (EIN):200262355
    NAIC Classification:522120
    NAIC Description:Savings Institutions

    Additional information about PEOPLESBANK

    Jurisdiction of Incorporation: Commonwealth of Massachusetts Corporations Division
    Incorporation Date:
    Company Identification Number: 000851855

    More information about PEOPLESBANK

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan PEOPLESBANK 125 PREMIUM CONVERSION PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5022019-01-01
    5022018-01-01
    5022017-01-01JANICE MAZZALLO
    5022016-01-01JANICE MAZZALLO
    5022015-01-01JANICE MAZZALLO
    5022014-01-01JANICE MAZZALLO JANICE MAZZALLO2015-07-30
    5022013-01-01JANICE MAZZALLO JANICE MAZZALLO2014-08-11
    5022012-01-01JANICE MAZZALLO
    5022011-01-01JANICE MAZZALLO
    5022010-01-01JANICE MAZZALLO
    5022009-01-01THOMAS SENECAL

    Plan Statistics for PEOPLESBANK 125 PREMIUM CONVERSION PLAN

    401k plan membership statisitcs for PEOPLESBANK 125 PREMIUM CONVERSION PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-01-01308
    Total number of active participants reported on line 7a of the Form 55002019-01-01246
    Number of retired or separated participants receiving benefits2019-01-0130
    Number of other retired or separated participants entitled to future benefits2019-01-010
    Total of all active and inactive participants2019-01-01276
    2018
    Total participants, beginning-of-year2018-01-01289
    Total number of active participants reported on line 7a of the Form 55002018-01-01275
    Number of retired or separated participants receiving benefits2018-01-0127
    Number of other retired or separated participants entitled to future benefits2018-01-010
    Total of all active and inactive participants2018-01-01302
    2017
    Total participants, beginning-of-year2017-01-01292
    Total number of active participants reported on line 7a of the Form 55002017-01-01289
    Number of retired or separated participants receiving benefits2017-01-0122
    Total of all active and inactive participants2017-01-01311
    Total participants2017-01-01311
    2016
    Total participants, beginning-of-year2016-01-01266
    Total number of active participants reported on line 7a of the Form 55002016-01-01278
    Number of retired or separated participants receiving benefits2016-01-0114
    Total of all active and inactive participants2016-01-01292
    Total participants2016-01-01292
    2015
    Total participants, beginning-of-year2015-01-01266
    Total number of active participants reported on line 7a of the Form 55002015-01-01268
    Number of retired or separated participants receiving benefits2015-01-011
    Total of all active and inactive participants2015-01-01269
    Total participants2015-01-01269
    2014
    Total participants, beginning-of-year2014-01-01193
    Total number of active participants reported on line 7a of the Form 55002014-01-01192
    Number of retired or separated participants receiving benefits2014-01-010
    Number of other retired or separated participants entitled to future benefits2014-01-010
    Total of all active and inactive participants2014-01-01192
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
    Total participants2014-01-01192
    2013
    Total participants, beginning-of-year2013-01-01240
    Total number of active participants reported on line 7a of the Form 55002013-01-01250
    Total of all active and inactive participants2013-01-01250
    Total participants2013-01-01250
    2012
    Total participants, beginning-of-year2012-01-01232
    Total number of active participants reported on line 7a of the Form 55002012-01-01240
    Total of all active and inactive participants2012-01-01240
    Total participants2012-01-01240
    2011
    Total participants, beginning-of-year2011-01-01233
    Total number of active participants reported on line 7a of the Form 55002011-01-01218
    Number of retired or separated participants receiving benefits2011-01-0114
    Number of other retired or separated participants entitled to future benefits2011-01-010
    Total of all active and inactive participants2011-01-01232
    Total participants2011-01-01232
    2010
    Total participants, beginning-of-year2010-01-01234
    Total number of active participants reported on line 7a of the Form 55002010-01-01218
    Number of retired or separated participants receiving benefits2010-01-0114
    Number of other retired or separated participants entitled to future benefits2010-01-010
    Total of all active and inactive participants2010-01-01232
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-011
    Total participants2010-01-01233
    2009
    Total participants, beginning-of-year2009-01-01188
    Total number of active participants reported on line 7a of the Form 55002009-01-01219
    Number of retired or separated participants receiving benefits2009-01-0114
    Number of other retired or separated participants entitled to future benefits2009-01-010
    Total of all active and inactive participants2009-01-01233
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-011
    Total participants2009-01-01234

    Form 5500 Responses

    2019
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Submission has been amendedNo
    2019-01-01This submission is the final filingNo
    2019-01-01This return/report is a short plan year return/report (less than 12 months)No
    2019-01-01Plan is a collectively bargained planNo
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan funding arrangement – General assets of the sponsorYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-01-01Type of plan entitySingle employer plan
    2018-01-01Submission has been amendedNo
    2018-01-01This submission is the final filingNo
    2018-01-01This return/report is a short plan year return/report (less than 12 months)No
    2018-01-01Plan is a collectively bargained planNo
    2018-01-01Plan funding arrangement – InsuranceYes
    2018-01-01Plan benefit arrangement – InsuranceYes
    2017
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01Submission has been amendedNo
    2017-01-01This submission is the final filingNo
    2017-01-01This return/report is a short plan year return/report (less than 12 months)No
    2017-01-01Plan is a collectively bargained planNo
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2016
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Submission has been amendedNo
    2016-01-01This submission is the final filingNo
    2016-01-01This return/report is a short plan year return/report (less than 12 months)No
    2016-01-01Plan is a collectively bargained planNo
    2016-01-01Plan funding arrangement – InsuranceYes
    2016-01-01Plan benefit arrangement – InsuranceYes
    2015
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01Submission has been amendedNo
    2015-01-01This submission is the final filingNo
    2015-01-01This return/report is a short plan year return/report (less than 12 months)No
    2015-01-01Plan is a collectively bargained planNo
    2015-01-01Plan funding arrangement – InsuranceYes
    2015-01-01Plan benefit arrangement – InsuranceYes
    2014
    2014-01-01Type of plan entitySingle employer plan
    2014-01-01First time form 5500 has been submittedYes
    2014-01-01Submission has been amendedNo
    2014-01-01This submission is the final filingNo
    2014-01-01This return/report is a short plan year return/report (less than 12 months)No
    2014-01-01Plan is a collectively bargained planNo
    2014-01-01Plan funding arrangement – InsuranceYes
    2014-01-01Plan benefit arrangement – InsuranceYes
    2013
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Submission has been amendedNo
    2013-01-01This submission is the final filingNo
    2013-01-01This return/report is a short plan year return/report (less than 12 months)No
    2013-01-01Plan is a collectively bargained planNo
    2013-01-01Plan funding arrangement – InsuranceYes
    2013-01-01Plan benefit arrangement – InsuranceYes
    2012
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Submission has been amendedNo
    2012-01-01This submission is the final filingNo
    2012-01-01This return/report is a short plan year return/report (less than 12 months)No
    2012-01-01Plan is a collectively bargained planNo
    2012-01-01Plan funding arrangement – InsuranceYes
    2012-01-01Plan benefit arrangement – InsuranceYes
    2011
    2011-01-01Type of plan entitySingle employer plan
    2011-01-01Submission has been amendedNo
    2011-01-01This submission is the final filingNo
    2011-01-01This return/report is a short plan year return/report (less than 12 months)No
    2011-01-01Plan is a collectively bargained planNo
    2011-01-01Plan funding arrangement – InsuranceYes
    2011-01-01Plan benefit arrangement – InsuranceYes
    2010
    2010-01-01Type of plan entitySingle employer plan
    2010-01-01Submission has been amendedNo
    2010-01-01This submission is the final filingNo
    2010-01-01This return/report is a short plan year return/report (less than 12 months)No
    2010-01-01Plan is a collectively bargained planNo
    2010-01-01Plan funding arrangement – InsuranceYes
    2010-01-01Plan benefit arrangement – InsuranceYes
    2009
    2009-01-01Type of plan entitySingle employer plan
    2009-01-01Submission has been amendedNo
    2009-01-01This submission is the final filingNo
    2009-01-01This return/report is a short plan year return/report (less than 12 months)No
    2009-01-01Plan is a collectively bargained planNo
    2009-01-01Plan funding arrangement – InsuranceYes
    2009-01-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
    Policy contract numberE5057872
    Policy instance 6
    Insurance contract or identification numberE5057872
    Number of Individuals Covered35
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $14,467
    Total amount of fees paid to insurance companyUSD $6,685
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENT, CANCER
    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 $24,211
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,437
    Amount paid for insurance broker fees596
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )
    Policy contract number171023182236
    Policy instance 5
    Insurance contract or identification number171023182236
    Number of Individuals Covered292
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $44,337
    Total amount of fees paid to insurance companyUSD $6,235
    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 $1,620,723
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $25,697
    Amount paid for insurance broker fees6235
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
    Policy contract number171023182236
    Policy instance 4
    Insurance contract or identification number171023182236
    Number of Individuals Covered279
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $41,991
    Total amount of fees paid to insurance companyUSD $8,708
    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 $1,509,926
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $24,914
    Amount paid for insurance broker fees8708
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
    Policy contract number784
    Policy instance 3
    Insurance contract or identification number784
    Number of Individuals Covered316
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedEAP
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $14,334
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number876863G
    Policy instance 2
    Insurance contract or identification number876863G
    Number of Individuals Covered279
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $11,226
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE
    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 $121,118
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,226
    Insurance broker organization code?3
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number014470
    Policy instance 1
    Insurance contract or identification number014470
    Number of Individuals Covered656
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $10,412
    Total amount of fees paid to insurance companyUSD $2,529
    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 $325,691
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,412
    Amount paid for insurance broker fees2529
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number876863G
    Policy instance 2
    Insurance contract or identification number876863G
    Number of Individuals Covered275
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $9,874
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, SUPPLEMENTAL AD&D, SUPPLEMENTAL LIFE, DEPENDENT LIFE
    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 $90,486
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
    Policy contract number784
    Policy instance 3
    Insurance contract or identification number784
    Number of Individuals Covered281
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedEAP
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $14,092
    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 number171023182236
    Policy instance 4
    Insurance contract or identification number171023182236
    Number of Individuals Covered313
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $49,819
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,655,631
    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 number014470
    Policy instance 1
    Insurance contract or identification number014470
    Number of Individuals Covered620
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $10,254
    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 $294,579
    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 number171023182236
    Policy instance 5
    Insurance contract or identification number171023182236
    Number of Individuals Covered229
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $35,671
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,184,043
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number876863G
    Policy instance 2
    Insurance contract or identification number876863G
    Number of Individuals Covered289
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $8,674
    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 BenefitYes
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, VOLUNTARY LIFE
    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 $78,270
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,674
    Insurance broker organization code?3
    Insurance broker nameK BENEFIT GROUP INC
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
    Policy contract number12700002-0143
    Policy instance 1
    Insurance contract or identification number12700002-0143
    Number of Individuals Covered224
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of fees paid to insurance companyUSD $5,971
    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
    Amount paid for insurance broker fees5971
    Insurance broker organization code?1
    Insurance broker nameMASS BANKERS ASSOCIATION
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12700002-005
    Policy instance 1
    Insurance contract or identification number12700002-005
    Number of Individuals Covered189
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of fees paid to insurance companyUSD $5,482
    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 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 $39,163
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees5482
    Additional information about fees paid to insurance brokerADMINISTRATION FEES
    Insurance broker nameMASS BANKERS ASSOC
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number221698
    Policy instance 2
    Insurance contract or identification number221698
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $7,270
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $73,049
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,666
    Insurance broker nameGOSS AND MCCLAIN INSURANCE AGENCY
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number221698
    Policy instance 2
    Insurance contract or identification number221698
    Number of Individuals Covered262
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $7,901
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $69,342
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,027
    Insurance broker nameK BENEFIT GROUP
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12700002-005
    Policy instance 1
    Insurance contract or identification number12700002-005
    Number of Individuals Covered192
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of fees paid to insurance companyUSD $4,764
    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 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 $36,645
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees4764
    Additional information about fees paid to insurance brokerADMINISTRATION FEES
    Insurance broker nameMASSACHUSETTS BANKERS ASSOCIATION
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number221698
    Policy instance 2
    Insurance contract or identification number221698
    Number of Individuals Covered250
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $7,274
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $67,444
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,825
    Insurance broker nameK BENEFITS GROUP
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12700002-005
    Policy instance 1
    Insurance contract or identification number12700002-005
    Number of Individuals Covered179
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $3,753
    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 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 $34,114
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees3753
    Additional information about fees paid to insurance brokerADMINISTRATION FEES
    Insurance broker nameMASSACHUSETTS BANKERS ASSOCIATION
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number221698
    Policy instance 2
    Insurance contract or identification number221698
    Number of Individuals Covered240
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $3,974
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $46,721
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,274
    Insurance broker organization code?3
    Insurance broker nameGOSS & MCLAIN INSURANCE AGENCY
    THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
    Policy contract number000860051977
    Policy instance 1
    Insurance contract or identification number000860051977
    Number of Individuals Covered232
    Insurance policy start date2011-12-01
    Insurance policy end date2012-11-30
    Total amount of commissions paid to insurance brokerUSD $454
    Total amount of fees paid to insurance companyUSD $0
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $3,026
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $454
    Insurance broker organization code?3
    Insurance broker nameGOSS & MCLAIN INSURANCE AGENCY
    DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
    Policy contract number015800007
    Policy instance 3
    Insurance contract or identification number015800007
    Number of Individuals Covered523
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $170,952
    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 number12700002-0005
    Policy instance 4
    Insurance contract or identification number12700002-0005
    Number of Individuals Covered170
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $3,578
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $32,528
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Insurance broker nameMASSACHUSETTS BANKERS ASSOCIATION
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12700002-0005
    Policy instance 4
    Insurance contract or identification number12700002-0005
    Number of Individuals Covered155
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $3,519
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $31,987
    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 numberG000622E
    Policy instance 2
    Insurance contract or identification numberG000622E
    Number of Individuals Covered192
    Insurance policy start date2011-01-01
    Insurance policy end date2012-01-01
    Total amount of commissions paid to insurance brokerUSD $1,924
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $19,236
    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 number000860051977
    Policy instance 1
    Insurance contract or identification number000860051977
    Number of Individuals Covered230
    Insurance policy start date2010-12-01
    Insurance policy end date2011-11-30
    Total amount of commissions paid to insurance brokerUSD $3,548
    Total amount of fees paid to insurance companyUSD $0
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $34,955
    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 number001580-1425
    Policy instance 3
    Insurance contract or identification number001580-1425
    Number of Individuals Covered501
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $145,485
    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 number001580-1425
    Policy instance 3
    Insurance contract or identification number001580-1425
    Number of Individuals Covered471
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $158,941
    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 number000860051977
    Policy instance 1
    Insurance contract or identification number000860051977
    Number of Individuals Covered218
    Insurance policy start date2009-12-01
    Insurance policy end date2010-11-30
    Total amount of commissions paid to insurance brokerUSD $3,430
    Total amount of fees paid to insurance companyUSD $0
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $33,036
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,430
    Additional information about fees paid to insurance brokerAGENT OR BROKER
    Insurance broker organization code?3
    Insurance broker nameGOSS & MCLAIN INSURANCE AGENCY
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
    Policy contract number12700002-0005
    Policy instance 4
    Insurance contract or identification number12700002-0005
    Number of Individuals Covered150
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $3,499
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $31,806
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Insurance broker nameMASSACHUSETTS BANKERS ASSOC
    MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
    Policy contract numberG000622E
    Policy instance 2
    Insurance contract or identification numberG000622E
    Number of Individuals Covered176
    Insurance policy start date2010-01-01
    Insurance policy end date2011-01-01
    Total amount of commissions paid to insurance brokerUSD $1,768
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $17,684
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,640
    Additional information about fees paid to insurance brokerAGENCY OR BROKER OF RECORD
    Insurance broker organization code?3
    Insurance broker nameWEBBER & GRINNELL INS AGENCY

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