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RIVERWOODS AT EXETER 401k Plan overview

Plan NameRIVERWOODS AT EXETER
Plan identification number 501

RIVERWOODS AT EXETER Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

RIVERWOODS AT EXETER has sponsored the creation of one or more 401k plans.

Company Name:RIVERWOODS AT EXETER
Employer identification number (EIN):020400703
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIVERWOODS AT EXETER

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-07-01
5012017-07-01DAWN BARKER DAWN BARKER2019-01-28
5012016-07-01DAWN BARKER DAWN BARKER2018-01-15
5012015-07-01DAWN BARKER DAWN BARKER2017-01-25
5012014-07-01DAWN BARKER DAWN BARKER2015-12-18
5012013-07-01DAWN BARKER DAWN BARKER2014-10-13
5012012-07-01DAWN BARKER DAWN BARKER2013-11-14
5012011-07-01DAWN BARKER DAWN BARKER2012-10-08
5012010-07-01DAWN BARKER DAWN BARKER2012-10-08
5012009-07-01DAWN BARKER DAWN BARKER2012-10-08
5012008-07-01DAWN BARKER DAWN BARKER2012-10-08
5012007-07-01DAWN BARKER DAWN BARKER2012-10-08
5012006-07-01DAWN BARKER DAWN BARKER2012-10-08

Plan Statistics for RIVERWOODS AT EXETER

401k plan membership statisitcs for RIVERWOODS AT EXETER

Measure Date Value
2018: RIVERWOODS AT EXETER 2018 401k membership
Total participants, beginning-of-year2018-07-01301
Total number of active participants reported on line 7a of the Form 55002018-07-01299
Number of retired or separated participants receiving benefits2018-07-015
Total of all active and inactive participants2018-07-01304
2017: RIVERWOODS AT EXETER 2017 401k membership
Total participants, beginning-of-year2017-07-01308
Total number of active participants reported on line 7a of the Form 55002017-07-01297
Number of retired or separated participants receiving benefits2017-07-014
Total of all active and inactive participants2017-07-01301
2016: RIVERWOODS AT EXETER 2016 401k membership
Total participants, beginning-of-year2016-07-01281
Total number of active participants reported on line 7a of the Form 55002016-07-01306
Number of retired or separated participants receiving benefits2016-07-012
Total of all active and inactive participants2016-07-01308
2015: RIVERWOODS AT EXETER 2015 401k membership
Total participants, beginning-of-year2015-07-01271
Total number of active participants reported on line 7a of the Form 55002015-07-01280
Number of retired or separated participants receiving benefits2015-07-011
Total of all active and inactive participants2015-07-01281
2014: RIVERWOODS AT EXETER 2014 401k membership
Total participants, beginning-of-year2014-07-01274
Total number of active participants reported on line 7a of the Form 55002014-07-01270
Number of retired or separated participants receiving benefits2014-07-011
Total of all active and inactive participants2014-07-01271
2013: RIVERWOODS AT EXETER 2013 401k membership
Total participants, beginning-of-year2013-07-01270
Total number of active participants reported on line 7a of the Form 55002013-07-01269
Number of retired or separated participants receiving benefits2013-07-015
Total of all active and inactive participants2013-07-01274
2012: RIVERWOODS AT EXETER 2012 401k membership
Total participants, beginning-of-year2012-07-01296
Total number of active participants reported on line 7a of the Form 55002012-07-01269
Number of retired or separated participants receiving benefits2012-07-011
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01270
2011: RIVERWOODS AT EXETER 2011 401k membership
Total participants, beginning-of-year2011-07-01239
Total number of active participants reported on line 7a of the Form 55002011-07-01296
Total of all active and inactive participants2011-07-01296
2010: RIVERWOODS AT EXETER 2010 401k membership
Total participants, beginning-of-year2010-07-01200
Total number of active participants reported on line 7a of the Form 55002010-07-01239
Total of all active and inactive participants2010-07-01239
2009: RIVERWOODS AT EXETER 2009 401k membership
Total participants, beginning-of-year2009-07-01200
Total number of active participants reported on line 7a of the Form 55002009-07-01200
Total of all active and inactive participants2009-07-01200
Total participants2009-07-010
2008: RIVERWOODS AT EXETER 2008 401k membership
Total participants, beginning-of-year2008-07-01196
Total number of active participants reported on line 7a of the Form 55002008-07-01200
Total of all active and inactive participants2008-07-01200
2007: RIVERWOODS AT EXETER 2007 401k membership
Total participants, beginning-of-year2007-07-01195
Total number of active participants reported on line 7a of the Form 55002007-07-01196
Total of all active and inactive participants2007-07-01196
2006: RIVERWOODS AT EXETER 2006 401k membership
Total participants, beginning-of-year2006-07-01195
Total number of active participants reported on line 7a of the Form 55002006-07-01195
Total of all active and inactive participants2006-07-01195

Form 5500 Responses for RIVERWOODS AT EXETER

2018: RIVERWOODS AT EXETER 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: RIVERWOODS AT EXETER 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: RIVERWOODS AT EXETER 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: RIVERWOODS AT EXETER 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: RIVERWOODS AT EXETER 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: RIVERWOODS AT EXETER 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: RIVERWOODS AT EXETER 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: RIVERWOODS AT EXETER 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: RIVERWOODS AT EXETER 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – InsuranceYes
2009: RIVERWOODS AT EXETER 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes
2008: RIVERWOODS AT EXETER 2008 form 5500 responses
2008-07-01Type of plan entitySingle employer plan
2008-07-01Submission has been amendedNo
2008-07-01This submission is the final filingNo
2008-07-01This return/report is a short plan year return/report (less than 12 months)No
2008-07-01Plan is a collectively bargained planNo
2008-07-01Plan funding arrangement – InsuranceYes
2008-07-01Plan benefit arrangement – InsuranceYes
2007: RIVERWOODS AT EXETER 2007 form 5500 responses
2007-07-01Type of plan entitySingle employer plan
2007-07-01Submission has been amendedNo
2007-07-01This submission is the final filingNo
2007-07-01This return/report is a short plan year return/report (less than 12 months)No
2007-07-01Plan is a collectively bargained planNo
2007-07-01Plan funding arrangement – InsuranceYes
2007-07-01Plan benefit arrangement – InsuranceYes
2006: RIVERWOODS AT EXETER 2006 form 5500 responses
2006-07-01Type of plan entitySingle employer plan
2006-07-01Submission has been amendedNo
2006-07-01This submission is the final filingNo
2006-07-01This return/report is a short plan year return/report (less than 12 months)No
2006-07-01Plan is a collectively bargained planNo
2006-07-01Plan funding arrangement – InsuranceYes
2006-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number910935
Policy instance 3
Insurance contract or identification number910935
Number of Individuals Covered299
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $12,569
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $117,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,569
Amount paid for insurance broker fees0
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 )
Policy contract number014796
Policy instance 2
Insurance contract or identification number014796
Number of Individuals Covered395
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $47,482
Total amount of fees paid to insurance companyUSD $7,434
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,544,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,482
Amount paid for insurance broker fees7434
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 )
Policy contract number000903545
Policy instance 1
Insurance contract or identification number000903545
Number of Individuals Covered225
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $1,873
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,629
Amount paid for insurance broker fees0
Insurance broker organization code?3
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 4
Insurance contract or identification number3545
Number of Individuals Covered417
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $9,084
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $204,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5476446
Policy instance 3
Insurance contract or identification number5476446
Number of Individuals Covered297
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $12,338
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $103,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 )
Policy contract number019278
Policy instance 2
Insurance contract or identification number019278
Number of Individuals Covered391
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $55,528
Total amount of fees paid to insurance companyUSD $8,866
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,341,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 )
Policy contract number000903545
Policy instance 1
Insurance contract or identification number000903545
Number of Individuals Covered193
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $1,672
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 4
Insurance contract or identification number3545
Number of Individuals Covered343
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $8,219
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $178,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,628
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCOMBINED SERVICES, LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5476446
Policy instance 3
Insurance contract or identification number5476446
Number of Individuals Covered280
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $13,366
Total amount of fees paid to insurance companyUSD $189
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $102,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,366
Amount paid for insurance broker fees189
Additional information about fees paid to insurance brokerNON MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number057528
Policy instance 2
Insurance contract or identification number057528
Number of Individuals Covered277
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $36,563
Total amount of fees paid to insurance companyUSD $5,145
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,450,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,563
Amount paid for insurance broker fees5145
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 )
Policy contract number089302
Policy instance 1
Insurance contract or identification number089302
Number of Individuals Covered38
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $6,252
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $248,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,252
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 3
Insurance contract or identification number3545
Number of Individuals Covered360
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $8,105
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $176,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,561
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCOMBINED SERVICES, LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 148778
Policy instance 2
Insurance contract or identification numberGL 148778
Number of Individuals Covered270
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $15,021
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $123,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,021
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number057528
Policy instance 1
Insurance contract or identification number057528
Number of Individuals Covered328
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $42,995
Total amount of fees paid to insurance companyUSD $18,920
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,652,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,995
Amount paid for insurance broker fees18920
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 3
Insurance contract or identification number3545
Number of Individuals Covered356
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $8,503
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $193,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,855
Insurance broker organization code?3
Insurance broker nameCOMBINED SERVICES, LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 148778
Policy instance 2
Insurance contract or identification numberGL 148778
Number of Individuals Covered269
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $16,066
Total amount of fees paid to insurance companyUSD $3,653
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $119,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,066
Amount paid for insurance broker fees3653
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number057528
Policy instance 1
Insurance contract or identification number057528
Number of Individuals Covered317
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $39,421
Total amount of fees paid to insurance companyUSD $20,936
Welfare Benefit Premiums Paid to CarrierUSD $1,651,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,421
Amount paid for insurance broker fees20936
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number057528
Policy instance 1
Insurance contract or identification number057528
Number of Individuals Covered319
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $43,696
Total amount of fees paid to insurance companyUSD $4,349
Welfare Benefit Premiums Paid to CarrierUSD $1,744,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,696
Amount paid for insurance broker fees4349
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 148778
Policy instance 2
Insurance contract or identification numberGL 148778
Number of Individuals Covered269
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $19,663
Total amount of fees paid to insurance companyUSD $3,376
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $134,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,663
Amount paid for insurance broker fees3376
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameGRANITE GROUP BENEFITS, LLC
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 3
Insurance contract or identification number3545
Number of Individuals Covered374
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $9,536
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $216,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,716
Insurance broker organization code?3
Insurance broker nameCOMBINED SERVICES, LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 148778
Policy instance 3
Insurance contract or identification numberGL 148778
Number of Individuals Covered296
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $12,819
Total amount of fees paid to insurance companyUSD $920
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $101,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number514154
Policy instance 1
Insurance contract or identification number514154
Number of Individuals Covered0
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $15
Total amount of fees paid to insurance companyUSD $516
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 4
Insurance contract or identification number3545
Number of Individuals Covered381
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $10,365
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $197,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number057528
Policy instance 2
Insurance contract or identification number057528
Number of Individuals Covered332
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $42,874
Total amount of fees paid to insurance companyUSD $6,284
Welfare Benefit Premiums Paid to CarrierUSD $1,661,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 3
Insurance contract or identification number3545
Number of Individuals Covered347
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $11,797
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $193,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number057528
Policy instance 2
Insurance contract or identification number057528
Number of Individuals Covered304
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $38,916
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,448,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number537366
Policy instance 1
Insurance contract or identification number537366
Number of Individuals Covered239
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $9,252
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $90,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number514154
Policy instance 2
Insurance contract or identification number514154
Number of Individuals Covered200
Insurance policy start date2008-07-01
Insurance policy end date2009-06-30
Total amount of commissions paid to insurance brokerUSD $8,802
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $87,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC. (National Association of Insurance Commissioners NAIC id number: 53759 )
Policy contract number357709
Policy instance 3
Insurance contract or identification number357709
Number of Individuals Covered146
Insurance policy start date2008-07-01
Insurance policy end date2009-06-30
Total amount of commissions paid to insurance brokerUSD $46,749
Total amount of fees paid to insurance companyUSD $7,104
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,474,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 1
Insurance contract or identification number3545
Number of Individuals Covered302
Insurance policy start date2008-07-01
Insurance policy end date2009-06-30
Total amount of commissions paid to insurance brokerUSD $8,282
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $133,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC. (National Association of Insurance Commissioners NAIC id number: 53759 )
Policy contract number357709
Policy instance 3
Insurance contract or identification number357709
Number of Individuals Covered139
Insurance policy start date2007-07-01
Insurance policy end date2008-06-30
Total amount of commissions paid to insurance brokerUSD $37,827
Total amount of fees paid to insurance companyUSD $1,385
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,213,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 2
Insurance contract or identification number3545
Number of Individuals Covered300
Insurance policy start date2007-07-01
Insurance policy end date2008-06-30
Total amount of commissions paid to insurance brokerUSD $8,243
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $131,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number514154
Policy instance 1
Insurance contract or identification number514154
Number of Individuals Covered196
Insurance policy start date2007-07-01
Insurance policy end date2008-06-30
Total amount of commissions paid to insurance brokerUSD $8,164
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $84,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH CARE OF NEW HAMPSHIRE, INC. (National Association of Insurance Commissioners NAIC id number: 95493 )
Policy contract number3033688
Policy instance 5
Insurance contract or identification number3033688
Number of Individuals Covered147
Insurance policy start date2006-07-01
Insurance policy end date2007-06-30
Total amount of commissions paid to insurance brokerUSD $40,625
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,358,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number537366
Policy instance 4
Insurance contract or identification number537366
Number of Individuals Covered195
Insurance policy start date2006-07-01
Insurance policy end date2007-06-30
Total amount of commissions paid to insurance brokerUSD $7,759
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $80,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTHCARE OF MAINE, INC. (National Association of Insurance Commissioners NAIC id number: 95447 )
Policy contract number3033688
Policy instance 2
Insurance contract or identification number3033688
Number of Individuals Covered6
Insurance policy start date2006-07-01
Insurance policy end date2007-06-30
Total amount of commissions paid to insurance brokerUSD $1,765
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $58,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHEAST DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47079 )
Policy contract number3545
Policy instance 1
Insurance contract or identification number3545
Number of Individuals Covered314
Insurance policy start date2006-07-01
Insurance policy end date2007-06-30
Total amount of commissions paid to insurance brokerUSD $9,101
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTHCARE OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 95520 )
Policy contract number3033688
Policy instance 3
Insurance contract or identification number3033688
Number of Individuals Covered5
Insurance policy start date2006-07-01
Insurance policy end date2007-06-30
Total amount of commissions paid to insurance brokerUSD $1,518
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $51,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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