BOARD OF TRUSTEES - HEALTH & WELFARE FUND IBEW LOCAL 96 has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH & WELFARE FUND IBEW LOCAL 96
| Measure | Date | Value |
|---|
| 2023 : HEALTH & WELFARE FUND IBEW LOCAL 96 2023 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $271,245 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $194,112 |
| Total income from all sources (including contributions) | 2023-12-31 | $6,484,277 |
| Total of all expenses incurred | 2023-12-31 | $5,612,293 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $5,378,078 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $5,753,851 |
| Value of total assets at end of year | 2023-12-31 | $10,593,092 |
| Value of total assets at beginning of year | 2023-12-31 | $9,643,975 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $234,215 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-12-31 | $291,716 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2023-12-31 | $291,716 |
| Was this plan covered by a fidelity bond | 2023-12-31 | Yes |
| Value of fidelity bond cover | 2023-12-31 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-12-31 | No |
| Contributions received from participants | 2023-12-31 | $443,242 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2023-12-31 | $133,246 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-12-31 | $422,190 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-12-31 | $407,803 |
| Other income not declared elsewhere | 2023-12-31 | $26,950 |
| Administrative expenses (other) incurred | 2023-12-31 | $20,423 |
| Liabilities. Value of operating payables at end of year | 2023-12-31 | $104,261 |
| Liabilities. Value of operating payables at beginning of year | 2023-12-31 | $173,634 |
| Total non interest bearing cash at end of year | 2023-12-31 | $727,403 |
| Total non interest bearing cash at beginning of year | 2023-12-31 | $387,985 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Value of net income/loss | 2023-12-31 | $871,984 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $10,321,847 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $9,449,863 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-12-31 | No |
| Assets. partnership/joint venture interests at end of year | 2023-12-31 | $794,536 |
| Assets. partnership/joint venture interests at beginning of year | 2023-12-31 | $948,911 |
| Investment advisory and management fees | 2023-12-31 | $17,113 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-12-31 | $8,021,211 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-12-31 | $7,173,873 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $5,049,549 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-12-31 | $411,760 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Contributions received in cash from employer | 2023-12-31 | $5,177,363 |
| Employer contributions (assets) at end of year | 2023-12-31 | $627,752 |
| Employer contributions (assets) at beginning of year | 2023-12-31 | $725,403 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-12-31 | $328,529 |
| Contract administrator fees | 2023-12-31 | $132,108 |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $166,984 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $20,478 |
| Did the plan have assets held for investment | 2023-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | NOVAK FRANCELLA, LLC |
| Accountancy firm EIN | 2023-12-31 | 611436956 |
| 2022 : HEALTH & WELFARE FUND IBEW LOCAL 96 2022 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2022-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $194,112 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $83,208 |
| Total income from all sources (including contributions) | 2022-12-31 | $4,276,375 |
| Total of all expenses incurred | 2022-12-31 | $5,675,350 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $5,434,314 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $5,417,542 |
| Value of total assets at end of year | 2022-12-31 | $9,643,975 |
| Value of total assets at beginning of year | 2022-12-31 | $10,932,046 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $241,036 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $205,459 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $205,459 |
| Administrative expenses professional fees incurred | 2022-12-31 | $77,893 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $560,448 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2022-12-31 | $205,367 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $407,803 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $440,547 |
| Other income not declared elsewhere | 2022-12-31 | $3,050 |
| Administrative expenses (other) incurred | 2022-12-31 | $20,681 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $173,634 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $54,525 |
| Total non interest bearing cash at end of year | 2022-12-31 | $387,985 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $267,640 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-1,398,975 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $9,449,863 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $10,848,838 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Assets. partnership/joint venture interests at end of year | 2022-12-31 | $948,911 |
| Investment advisory and management fees | 2022-12-31 | $8,966 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $7,173,873 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $9,668,090 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $5,247,495 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-1,349,676 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $4,651,727 |
| Employer contributions (assets) at end of year | 2022-12-31 | $725,403 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $555,769 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $186,819 |
| Contract administrator fees | 2022-12-31 | $133,496 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $20,478 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $28,683 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | NOVAK FRANCELLA, LLC |
| Accountancy firm EIN | 2022-12-31 | 611436956 |
| 2021 : HEALTH & WELFARE FUND IBEW LOCAL 96 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $83,208 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $115,554 |
| Total income from all sources (including contributions) | 2021-12-31 | $6,319,861 |
| Total of all expenses incurred | 2021-12-31 | $5,721,677 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $5,512,306 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $5,587,395 |
| Value of total assets at end of year | 2021-12-31 | $10,932,046 |
| Value of total assets at beginning of year | 2021-12-31 | $10,366,208 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $209,371 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $179,181 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-12-31 | $179,181 |
| Administrative expenses professional fees incurred | 2021-12-31 | $54,211 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $646,905 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $82,135 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $440,547 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $403,201 |
| Other income not declared elsewhere | 2021-12-31 | $55,352 |
| Administrative expenses (other) incurred | 2021-12-31 | $11,511 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $54,525 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $96,463 |
| Total non interest bearing cash at end of year | 2021-12-31 | $267,640 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $175,122 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $598,184 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $10,848,838 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $10,250,654 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $6,600 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $9,668,090 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $8,990,977 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $5,273,781 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-12-31 | $497,933 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $4,858,355 |
| Employer contributions (assets) at end of year | 2021-12-31 | $555,769 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $796,908 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $238,525 |
| Contract administrator fees | 2021-12-31 | $137,049 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $28,683 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $19,091 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | NOVAK FRANCELLA, LLC |
| Accountancy firm EIN | 2021-12-31 | 611436956 |
| 2020 : HEALTH & WELFARE FUND IBEW LOCAL 96 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $115,554 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $127,905 |
| Total income from all sources (including contributions) | 2020-12-31 | $5,774,348 |
| Total of all expenses incurred | 2020-12-31 | $5,346,683 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $5,121,225 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $4,927,495 |
| Value of total assets at end of year | 2020-12-31 | $10,366,208 |
| Value of total assets at beginning of year | 2020-12-31 | $9,950,894 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $225,458 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $210,636 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-12-31 | $210,636 |
| Administrative expenses professional fees incurred | 2020-12-31 | $65,195 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $483,210 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-12-31 | $161,864 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $403,201 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $383,061 |
| Other income not declared elsewhere | 2020-12-31 | $4,880 |
| Administrative expenses (other) incurred | 2020-12-31 | $14,196 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $96,463 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $109,840 |
| Total non interest bearing cash at end of year | 2020-12-31 | $175,122 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $716,085 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $427,665 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $10,250,654 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $9,822,989 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Investment advisory and management fees | 2020-12-31 | $7,133 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $8,990,977 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $8,149,004 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $4,857,585 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-12-31 | $631,337 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $4,282,421 |
| Employer contributions (assets) at end of year | 2020-12-31 | $796,908 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $702,744 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $263,640 |
| Contract administrator fees | 2020-12-31 | $138,934 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $19,091 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $18,065 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | NOVAK FRANCELLA, LLC |
| Accountancy firm EIN | 2020-12-31 | 611436956 |
| 2019 : HEALTH & WELFARE FUND IBEW LOCAL 96 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $127,905 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $127,905 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $46,524 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $46,524 |
| Total income from all sources (including contributions) | 2019-12-31 | $5,729,253 |
| Total income from all sources (including contributions) | 2019-12-31 | $5,729,253 |
| Total of all expenses incurred | 2019-12-31 | $5,340,945 |
| Total of all expenses incurred | 2019-12-31 | $5,340,945 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $5,117,251 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $5,117,251 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $4,872,291 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $4,872,291 |
| Value of total assets at end of year | 2019-12-31 | $9,950,894 |
| Value of total assets at end of year | 2019-12-31 | $9,950,894 |
| Value of total assets at beginning of year | 2019-12-31 | $9,481,205 |
| Value of total assets at beginning of year | 2019-12-31 | $9,481,205 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $223,694 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $223,694 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $216,730 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $216,730 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $216,730 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $216,730 |
| Administrative expenses professional fees incurred | 2019-12-31 | $80,349 |
| Administrative expenses professional fees incurred | 2019-12-31 | $80,349 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $3,000,000 |
| Value of fidelity bond cover | 2019-12-31 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $597,023 |
| Contributions received from participants | 2019-12-31 | $597,023 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $693,277 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $693,277 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $383,061 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $383,061 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $398,588 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $398,588 |
| Other income not declared elsewhere | 2019-12-31 | $6,186 |
| Other income not declared elsewhere | 2019-12-31 | $6,186 |
| Administrative expenses (other) incurred | 2019-12-31 | $39,305 |
| Administrative expenses (other) incurred | 2019-12-31 | $39,305 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $109,840 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $109,840 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $21,525 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $21,525 |
| Total non interest bearing cash at end of year | 2019-12-31 | $716,085 |
| Total non interest bearing cash at end of year | 2019-12-31 | $716,085 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $240,879 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $240,879 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $388,308 |
| Value of net income/loss | 2019-12-31 | $388,308 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $9,822,989 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $9,822,989 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $9,434,681 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $9,434,681 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Investment advisory and management fees | 2019-12-31 | $6,600 |
| Investment advisory and management fees | 2019-12-31 | $6,600 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $8,149,004 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $8,149,004 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $8,398,242 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $8,398,242 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $4,775,284 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $4,775,284 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-12-31 | $634,046 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-12-31 | $634,046 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $3,581,991 |
| Contributions received in cash from employer | 2019-12-31 | $3,581,991 |
| Employer contributions (assets) at end of year | 2019-12-31 | $702,744 |
| Employer contributions (assets) at end of year | 2019-12-31 | $702,744 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $443,496 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $443,496 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $341,967 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $341,967 |
| Contract administrator fees | 2019-12-31 | $97,440 |
| Contract administrator fees | 2019-12-31 | $97,440 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $18,065 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $18,065 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $24,999 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $24,999 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | NOVAK FRANCELLA LLC |
| Accountancy firm name | 2019-12-31 | NOVAK FRANCELLA LLC |
| Accountancy firm EIN | 2019-12-31 | 611436956 |
| Accountancy firm EIN | 2019-12-31 | 611436956 |
| 2018 : HEALTH & WELFARE FUND IBEW LOCAL 96 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $46,524 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $72,144 |
| Total income from all sources (including contributions) | 2018-12-31 | $4,869,679 |
| Total of all expenses incurred | 2018-12-31 | $5,675,680 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $5,458,491 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $4,898,468 |
| Value of total assets at end of year | 2018-12-31 | $9,481,205 |
| Value of total assets at beginning of year | 2018-12-31 | $10,312,826 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $217,189 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $211,835 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-12-31 | $211,835 |
| Administrative expenses professional fees incurred | 2018-12-31 | $67,502 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $551,853 |
| Participant contributions at beginning of year | 2018-12-31 | $2,375 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-12-31 | $1,264,021 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $398,588 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $407,677 |
| Other income not declared elsewhere | 2018-12-31 | $15,451 |
| Administrative expenses (other) incurred | 2018-12-31 | $18,949 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $21,525 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $52,889 |
| Total non interest bearing cash at end of year | 2018-12-31 | $240,879 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $195,777 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-806,001 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $9,434,681 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $10,240,682 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Investment advisory and management fees | 2018-12-31 | $6,600 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-12-31 | $8,398,242 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-12-31 | $9,017,482 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $5,149,958 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-12-31 | $-256,075 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $3,082,594 |
| Employer contributions (assets) at end of year | 2018-12-31 | $443,496 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $689,515 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $308,533 |
| Contract administrator fees | 2018-12-31 | $124,138 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $24,999 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $19,255 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | NOVAK FRANCELLA, LLC |
| Accountancy firm EIN | 2018-12-31 | 611436956 |
| 2017 : HEALTH & WELFARE FUND IBEW LOCAL 96 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $72,144 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $646,082 |
| Total income from all sources (including contributions) | 2017-12-31 | $5,544,985 |
| Total loss/gain on sale of assets | 2017-12-31 | $0 |
| Total of all expenses incurred | 2017-12-31 | $5,202,396 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $4,994,402 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $4,894,893 |
| Value of total assets at end of year | 2017-12-31 | $10,312,826 |
| Value of total assets at beginning of year | 2017-12-31 | $10,544,175 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $207,994 |
| Total interest from all sources | 2017-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $226,599 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-12-31 | $226,599 |
| Administrative expenses professional fees incurred | 2017-12-31 | $91,446 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $617,958 |
| Participant contributions at end of year | 2017-12-31 | $2,375 |
| Participant contributions at beginning of year | 2017-12-31 | $2,375 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-12-31 | $63,778 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $407,677 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $372,746 |
| Other income not declared elsewhere | 2017-12-31 | $159 |
| Administrative expenses (other) incurred | 2017-12-31 | $14,624 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $52,889 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $629,475 |
| Total non interest bearing cash at end of year | 2017-12-31 | $195,777 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $528,821 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $342,589 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $10,240,682 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $9,898,093 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Investment advisory and management fees | 2017-12-31 | $8,288 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-12-31 | $9,017,482 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-12-31 | $8,742,549 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $4,708,180 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-12-31 | $423,334 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $4,213,157 |
| Employer contributions (assets) at end of year | 2017-12-31 | $689,515 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $897,684 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $286,222 |
| Contract administrator fees | 2017-12-31 | $93,636 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $19,255 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $16,607 |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | NOVAK FRANCELLA, LLC |
| Accountancy firm EIN | 2017-12-31 | 611436956 |
| 2016 : HEALTH & WELFARE FUND IBEW LOCAL 96 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $646,082 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $126,685 |
| Total income from all sources (including contributions) | 2016-12-31 | $5,439,950 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $5,489,809 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $4,361,787 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $5,127,663 |
| Value of total assets at end of year | 2016-12-31 | $10,544,175 |
| Value of total assets at beginning of year | 2016-12-31 | $10,074,637 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $1,128,022 |
| Total interest from all sources | 2016-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $162,543 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-12-31 | $162,543 |
| Administrative expenses professional fees incurred | 2016-12-31 | $61,312 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $461,230 |
| Participant contributions at end of year | 2016-12-31 | $2,375 |
| Participant contributions at beginning of year | 2016-12-31 | $444 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $372,746 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $327,151 |
| Other income not declared elsewhere | 2016-12-31 | $758 |
| Administrative expenses (other) incurred | 2016-12-31 | $938,743 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $629,475 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $101,461 |
| Total non interest bearing cash at end of year | 2016-12-31 | $528,821 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $599,867 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $-49,859 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $9,898,093 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $9,947,952 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Investment advisory and management fees | 2016-12-31 | $6,600 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-12-31 | $8,742,549 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-12-31 | $8,681,019 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $4,063,439 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-12-31 | $148,986 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $4,666,433 |
| Employer contributions (assets) at end of year | 2016-12-31 | $897,684 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $466,156 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $298,348 |
| Contract administrator fees | 2016-12-31 | $121,367 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $16,607 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $25,224 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | BUCKLEY, FRAME, BOUDREAU |
| Accountancy firm EIN | 2016-12-31 | 060931761 |
| 2015 : HEALTH & WELFARE FUND IBEW LOCAL 96 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $126,685 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $107,362 |
| Total income from all sources (including contributions) | 2015-12-31 | $3,805,799 |
| Total loss/gain on sale of assets | 2015-12-31 | $0 |
| Total of all expenses incurred | 2015-12-31 | $4,222,947 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $4,040,722 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $3,645,855 |
| Value of total assets at end of year | 2015-12-31 | $10,074,637 |
| Value of total assets at beginning of year | 2015-12-31 | $10,472,462 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $182,225 |
| Total interest from all sources | 2015-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $240,590 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-12-31 | $240,590 |
| Administrative expenses professional fees incurred | 2015-12-31 | $39,264 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $535,092 |
| Participant contributions at end of year | 2015-12-31 | $444 |
| Participant contributions at beginning of year | 2015-12-31 | $1,182 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $327,151 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $302,829 |
| Other income not declared elsewhere | 2015-12-31 | $8,462 |
| Administrative expenses (other) incurred | 2015-12-31 | $15,575 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $101,461 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $91,924 |
| Total non interest bearing cash at end of year | 2015-12-31 | $599,867 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $331,740 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-417,148 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $9,947,952 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $10,365,100 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Investment advisory and management fees | 2015-12-31 | $6,600 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $8,681,019 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $9,404,539 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $3,722,469 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-12-31 | $-89,108 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $3,110,763 |
| Employer contributions (assets) at end of year | 2015-12-31 | $466,156 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $432,172 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $318,253 |
| Contract administrator fees | 2015-12-31 | $120,786 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $25,224 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $15,438 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | BUCKLEY, FRAME, BOUDREAU |
| Accountancy firm EIN | 2015-12-31 | 060931761 |
| 2014 : HEALTH & WELFARE FUND IBEW LOCAL 96 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $107,362 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $67,416 |
| Total income from all sources (including contributions) | 2014-12-31 | $4,276,433 |
| Total loss/gain on sale of assets | 2014-12-31 | $0 |
| Total of all expenses incurred | 2014-12-31 | $4,220,346 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $4,021,856 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $3,940,979 |
| Value of total assets at end of year | 2014-12-31 | $10,472,462 |
| Value of total assets at beginning of year | 2014-12-31 | $10,376,429 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $198,490 |
| Total interest from all sources | 2014-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $232,675 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-12-31 | $232,675 |
| Administrative expenses professional fees incurred | 2014-12-31 | $58,172 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $493,648 |
| Participant contributions at end of year | 2014-12-31 | $1,182 |
| Participant contributions at beginning of year | 2014-12-31 | $5,463 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $302,829 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $270,370 |
| Other income not declared elsewhere | 2014-12-31 | $6,522 |
| Administrative expenses (other) incurred | 2014-12-31 | $13,175 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $91,924 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $45,691 |
| Total non interest bearing cash at end of year | 2014-12-31 | $331,740 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $56,087 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $10,365,100 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $10,309,013 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Investment advisory and management fees | 2014-12-31 | $6,600 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $9,404,539 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $9,685,607 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $136,362 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $136,362 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $3,711,753 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-12-31 | $96,257 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $3,447,331 |
| Employer contributions (assets) at end of year | 2014-12-31 | $432,172 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $278,627 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $310,103 |
| Contract administrator fees | 2014-12-31 | $120,543 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $15,438 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $21,725 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | BUCKLEY, FRAME, BOUDREAU |
| Accountancy firm EIN | 2014-12-31 | 060931761 |
| 2013 : HEALTH & WELFARE FUND IBEW LOCAL 96 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $67,416 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $77,103 |
| Total income from all sources (including contributions) | 2013-12-31 | $4,334,582 |
| Total loss/gain on sale of assets | 2013-12-31 | $0 |
| Total of all expenses incurred | 2013-12-31 | $4,534,550 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $4,361,570 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $3,464,138 |
| Value of total assets at end of year | 2013-12-31 | $10,376,429 |
| Value of total assets at beginning of year | 2013-12-31 | $10,586,084 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $172,980 |
| Total interest from all sources | 2013-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $133,561 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-12-31 | $133,561 |
| Administrative expenses professional fees incurred | 2013-12-31 | $45,732 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $487,389 |
| Participant contributions at end of year | 2013-12-31 | $5,463 |
| Participant contributions at beginning of year | 2013-12-31 | $1,300 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $270,370 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $343,077 |
| Other income not declared elsewhere | 2013-12-31 | $3,191 |
| Administrative expenses (other) incurred | 2013-12-31 | $18,377 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $45,691 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $51,951 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-199,968 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $10,309,013 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $10,508,981 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Investment advisory and management fees | 2013-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-12-31 | $9,685,607 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-12-31 | $9,723,357 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $136,362 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $171,632 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $171,632 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $4,091,642 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-12-31 | $733,692 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $2,976,749 |
| Employer contributions (assets) at end of year | 2013-12-31 | $278,627 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $346,718 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $269,928 |
| Contract administrator fees | 2013-12-31 | $102,871 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $21,725 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $25,152 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | BUCKLEY, FRAME, BOUDREAU |
| Accountancy firm EIN | 2013-12-31 | 060931761 |
| 2012 : HEALTH & WELFARE FUND IBEW LOCAL 96 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $77,103 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $66,042 |
| Total income from all sources (including contributions) | 2012-12-31 | $4,809,202 |
| Total loss/gain on sale of assets | 2012-12-31 | $0 |
| Total of all expenses incurred | 2012-12-31 | $4,933,187 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $4,757,493 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $4,156,394 |
| Value of total assets at end of year | 2012-12-31 | $10,586,084 |
| Value of total assets at beginning of year | 2012-12-31 | $10,699,008 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $175,694 |
| Total interest from all sources | 2012-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $170,182 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-12-31 | $170,182 |
| Administrative expenses professional fees incurred | 2012-12-31 | $48,954 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $567,802 |
| Participant contributions at end of year | 2012-12-31 | $1,300 |
| Participant contributions at beginning of year | 2012-12-31 | $1,531 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $343,077 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $339,947 |
| Other income not declared elsewhere | 2012-12-31 | $10,616 |
| Administrative expenses (other) incurred | 2012-12-31 | $16,004 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $51,951 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $31,585 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-123,985 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $10,508,981 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $10,632,966 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Investment advisory and management fees | 2012-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-12-31 | $9,723,357 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-12-31 | $9,721,164 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $171,632 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $130,771 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $130,771 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $4,445,239 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-12-31 | $472,010 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $3,588,592 |
| Employer contributions (assets) at end of year | 2012-12-31 | $346,718 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $505,595 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $312,254 |
| Contract administrator fees | 2012-12-31 | $104,736 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $25,152 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $34,457 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | BUCKLEY, FRAME, BOUDREAU |
| Accountancy firm EIN | 2012-12-31 | 060931761 |
| 2011 : HEALTH & WELFARE FUND IBEW LOCAL 96 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $66,042 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $58,983 |
| Total income from all sources (including contributions) | 2011-12-31 | $4,498,879 |
| Total loss/gain on sale of assets | 2011-12-31 | $0 |
| Total of all expenses incurred | 2011-12-31 | $4,955,333 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $4,780,639 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $4,209,128 |
| Value of total assets at end of year | 2011-12-31 | $10,699,008 |
| Value of total assets at beginning of year | 2011-12-31 | $11,148,403 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $174,694 |
| Total interest from all sources | 2011-12-31 | $19 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $221,928 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-12-31 | $221,928 |
| Administrative expenses professional fees incurred | 2011-12-31 | $43,542 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $547,957 |
| Participant contributions at end of year | 2011-12-31 | $1,531 |
| Participant contributions at beginning of year | 2011-12-31 | $1,282 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $339,947 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $321,625 |
| Other income not declared elsewhere | 2011-12-31 | $45,030 |
| Administrative expenses (other) incurred | 2011-12-31 | $16,677 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $31,585 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $26,413 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-456,454 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $10,632,966 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $11,089,420 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Investment advisory and management fees | 2011-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-12-31 | $9,721,164 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-12-31 | $10,196,463 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $130,771 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $245,063 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $245,063 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $19 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $4,399,942 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-12-31 | $22,774 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $3,661,171 |
| Employer contributions (assets) at end of year | 2011-12-31 | $505,595 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $383,970 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $380,697 |
| Contract administrator fees | 2011-12-31 | $108,475 |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $34,457 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $32,570 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | BUCKLEY, FRAME, BOUDREAU |
| Accountancy firm EIN | 2011-12-31 | 060931761 |
| 2010 : HEALTH & WELFARE FUND IBEW LOCAL 96 2010 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $58,983 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $52,057 |
| Total income from all sources (including contributions) | 2010-12-31 | $4,517,989 |
| Total loss/gain on sale of assets | 2010-12-31 | $0 |
| Total of all expenses incurred | 2010-12-31 | $4,821,631 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $4,658,488 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $3,885,313 |
| Value of total assets at end of year | 2010-12-31 | $11,148,403 |
| Value of total assets at beginning of year | 2010-12-31 | $11,445,119 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $163,143 |
| Total interest from all sources | 2010-12-31 | $25 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $265,545 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2010-12-31 | $265,545 |
| Administrative expenses professional fees incurred | 2010-12-31 | $37,256 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $524,298 |
| Participant contributions at end of year | 2010-12-31 | $1,282 |
| Participant contributions at beginning of year | 2010-12-31 | $1,325 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $321,625 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $2,308 |
| Other income not declared elsewhere | 2010-12-31 | $15,731 |
| Administrative expenses (other) incurred | 2010-12-31 | $12,776 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $26,413 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $20,303 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-303,642 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $11,089,420 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $11,393,062 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Investment advisory and management fees | 2010-12-31 | $3,077 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2010-12-31 | $10,196,463 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2010-12-31 | $10,834,541 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $245,063 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $252,185 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $252,185 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $25 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $4,203,724 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2010-12-31 | $351,375 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $3,361,015 |
| Employer contributions (assets) at end of year | 2010-12-31 | $383,970 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $354,760 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $454,764 |
| Contract administrator fees | 2010-12-31 | $110,034 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $32,570 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $31,754 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | BUCKLEY, FRAME, BOUDREAU |
| Accountancy firm EIN | 2010-12-31 | 060931761 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $515,368 | | 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 number | 804179G |
| Policy instance | 2 |
| Insurance contract or identification number | 804179G | | Number of Individuals Covered | 372 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $53,799 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 555 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,713,908 | | 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 number | |
| Policy instance | 4 |
| Number of Individuals Covered | 14 | | Insurance policy start date | 2023-07-01 | | Insurance policy end date | 2024-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,038 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 551 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,841,850 | | 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 number | |
| Policy instance | 4 |
| Number of Individuals Covered | 5 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,615 | | 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 number | 804179G |
| Policy instance | 2 |
| Insurance contract or identification number | 804179G | | Number of Individuals Covered | 384 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $65,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $263,094 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 584 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,499,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $497,217 | | 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 number | 804179G |
| Policy instance | 2 |
| Insurance contract or identification number | 804179G | | Number of Individuals Covered | 400 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $60,301 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 605 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,558,259 | | 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 number | 804179G |
| Policy instance | 2 |
| Insurance contract or identification number | 804179G | | Number of Individuals Covered | 398 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $56,727 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $498,960 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 605 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,189,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 0839237 |
| Policy instance | 2 |
| Insurance contract or identification number | 0839237 | | Number of Individuals Covered | 409 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $55,024 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $493,856 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 671 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,592,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 0839237 |
| Policy instance | 2 |
| Insurance contract or identification number | 0839237 | | Number of Individuals Covered | 431 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $57,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $500,696 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $491,082 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 0839237 |
| Policy instance | 2 |
| Insurance contract or identification number | 0839237 | | Number of Individuals Covered | 411 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & 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 Carrier | USD $56,929 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 671 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $4,592,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $407,377 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 0839237 |
| Policy instance | 2 |
| Insurance contract or identification number | 0839237 | | Number of Individuals Covered | 384 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & 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 Carrier | USD $48,335 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 637 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $3,263,525 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 0839237 |
| Policy instance | 2 |
| Insurance contract or identification number | 0839237 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & 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 Carrier | USD $50,005 | | 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 number | 79740000 |
| Policy instance | 1 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $3,282,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4957635 |
| Policy instance | 3 |
| Insurance contract or identification number | 4957635 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $371,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | 2262167 |
| Policy instance | 2 |
| Insurance contract or identification number | 2262167 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $238,927 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 0839237 |
| Policy instance | 5 |
| Insurance contract or identification number | 0839237 | | Number of Individuals Covered | 421 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | 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 |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002262167C01 |
| Policy instance | 4 |
| Insurance contract or identification number | C002262167C01 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $243,316 | | 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 number | G1147SD |
| Policy instance | 1 |
| Insurance contract or identification number | G1147SD | | Number of Individuals Covered | 93 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $162,572 | | 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 number | 79740000 |
| Policy instance | 3 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 265 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $3,600,336 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | 2262167 |
| Policy instance | 2 |
| Insurance contract or identification number | 2262167 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $228,138 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C002262167C01 |
| Policy instance | 6 |
| Insurance contract or identification number | C002262167C01 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $4,550 | | 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 number | 79740000 |
| Policy instance | 5 |
| Insurance contract or identification number | 79740000 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $2,307,778 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4954883 |
| Policy instance | 4 |
| Insurance contract or identification number | 4954883 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $2,046,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
| Policy contract number | 2386 |
| Policy instance | 3 |
| Insurance contract or identification number | 2386 | | Number of Individuals Covered | 447 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&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 Carrier | USD $45,431 | | 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 number | G1147SD |
| Policy instance | 1 |
| Insurance contract or identification number | G1147SD | | Number of Individuals Covered | 78 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $140,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4954883 |
| Policy instance | 4 |
| Insurance contract or identification number | 4954883 | | Number of Individuals Covered | 308 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $422,277 | | 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 number | G1147S/D |
| Policy instance | 6 |
| Insurance contract or identification number | G1147S/D | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $2,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | 2262167 |
| Policy instance | 2 |
| Insurance contract or identification number | 2262167 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $233,992 | | 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 number | 76504065 |
| Policy instance | 7 |
| Insurance contract or identification number | 76504065 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $117,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | 2262167 |
| Policy instance | 5 |
| Insurance contract or identification number | 2262167 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | FHLAC | | 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 Carrier | USD $12,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
| Policy contract number | 2386 |
| Policy instance | 3 |
| Insurance contract or identification number | 2386 | | Number of Individuals Covered | 453 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&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 Carrier | USD $59,773 | | 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 number | G1147 |
| Policy instance | 1 |
| Insurance contract or identification number | G1147 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $38,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | 2262167 |
| Policy instance | 5 |
| Insurance contract or identification number | 2262167 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | FHLAC | | 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 Carrier | USD $11,808 | | 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 number | G1147 |
| Policy instance | 1 |
| Insurance contract or identification number | G1147 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $3,519 | | 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 number | 76504065 |
| Policy instance | 7 |
| Insurance contract or identification number | 76504065 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $111,753 | | 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 number | G1147S/D |
| Policy instance | 6 |
| Insurance contract or identification number | G1147S/D | | Number of Individuals Covered | 10 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $23,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4954883 |
| Policy instance | 4 |
| Insurance contract or identification number | 4954883 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $3,766,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
| Policy contract number | 2386 |
| Policy instance | 3 |
| Insurance contract or identification number | 2386 | | Number of Individuals Covered | 478 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&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 Carrier | USD $65,187 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | 2262167 |
| Policy instance | 2 |
| Insurance contract or identification number | 2262167 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $217,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
