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PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 401k Plan overview

Plan NamePRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK
Plan identification number 503

PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BEHAVIORAL HEALTH NETWORK, INC. has sponsored the creation of one or more 401k plans.

Company Name:BEHAVIORAL HEALTH NETWORK, INC.
Employer identification number (EIN):042103756
NAIC Classification:624100
NAIC Description: Individual and Family Services

Additional information about BEHAVIORAL HEALTH NETWORK, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1966-03-02
Company Identification Number: 196038
Legal Registered Office Address: ATTN: GENERAL COUNSEL
89 GENESEE STREET
ROCHESTER
United States of America (USA)
14611

More information about BEHAVIORAL HEALTH NETWORK, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-07-01STEWART JOSLIN2024-02-01 STEWART JOSLIN2024-02-01
5032021-07-01STEWART JOSLIN2023-01-04 STEWART JOSLIN2023-01-04
5032020-07-01STEWART JOSLIN2022-04-01 STEWART JOSLIN2022-04-01
5032019-07-01STEWART JOSLIN2021-03-02 STEWART JOSLIN2021-03-02
5032018-07-01RICHARD FOLLETT2020-04-03 RICHARD FOLLETT2020-04-03
5032017-07-01
5032016-07-01RICHARD FOLLETT RICHARD FOLLETT2018-04-16
5032015-07-01RICHARD FOLLETT RICHARD FOLLETT2017-04-18
5032014-07-01RICHARD FOLLETT RICHARD FOLLETT2016-01-28
5032013-07-01RICHARD FOLLETT RICHARD FOLLETT2015-03-10
5032012-07-01RICHARD FOLLETT RICHARD FOLLETT2014-01-29
5032011-07-01DEREK MORRIS DEREK MORRIS2013-01-25
5032010-07-01DEREK MORRIS DEREK MORRIS2012-01-31
5032009-07-01DEREK MORRIS
5032008-07-01
5032007-07-01DEREK MORRIS DEREK MORRIS2010-08-09

Plan Statistics for PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK

401k plan membership statisitcs for PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK

Measure Date Value
2022: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2022 401k membership
Total participants, beginning-of-year2022-07-011,574
Total number of active participants reported on line 7a of the Form 55002022-07-011,657
Number of retired or separated participants receiving benefits2022-07-018
Total of all active and inactive participants2022-07-011,665
2021: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2021 401k membership
Total participants, beginning-of-year2021-07-011,424
Total number of active participants reported on line 7a of the Form 55002021-07-011,573
Number of retired or separated participants receiving benefits2021-07-011
Total of all active and inactive participants2021-07-011,574
2020: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2020 401k membership
Total participants, beginning-of-year2020-07-011,365
Total number of active participants reported on line 7a of the Form 55002020-07-011,416
Number of retired or separated participants receiving benefits2020-07-018
Total of all active and inactive participants2020-07-011,424
2019: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2019 401k membership
Total participants, beginning-of-year2019-07-011,390
Total number of active participants reported on line 7a of the Form 55002019-07-011,352
Number of retired or separated participants receiving benefits2019-07-0113
Total of all active and inactive participants2019-07-011,365
2018: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2018 401k membership
Total participants, beginning-of-year2018-07-011,091
Total number of active participants reported on line 7a of the Form 55002018-07-011,378
Number of retired or separated participants receiving benefits2018-07-0112
Total of all active and inactive participants2018-07-011,390
2017: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2017 401k membership
Total participants, beginning-of-year2017-07-011,215
Total number of active participants reported on line 7a of the Form 55002017-07-011,086
Number of retired or separated participants receiving benefits2017-07-015
Total of all active and inactive participants2017-07-011,091
2016: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2016 401k membership
Total participants, beginning-of-year2016-07-011,132
Total number of active participants reported on line 7a of the Form 55002016-07-011,205
Number of retired or separated participants receiving benefits2016-07-0110
Total of all active and inactive participants2016-07-011,215
2015: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2015 401k membership
Total participants, beginning-of-year2015-07-01841
Total number of active participants reported on line 7a of the Form 55002015-07-011,132
Number of retired or separated participants receiving benefits2015-07-016
Total of all active and inactive participants2015-07-011,138
2014: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2014 401k membership
Total participants, beginning-of-year2014-07-011,140
Total number of active participants reported on line 7a of the Form 55002014-07-01836
Number of retired or separated participants receiving benefits2014-07-015
Total of all active and inactive participants2014-07-01841
2013: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2013 401k membership
Total participants, beginning-of-year2013-07-011,300
Total number of active participants reported on line 7a of the Form 55002013-07-012,559
Number of retired or separated participants receiving benefits2013-07-016
Total of all active and inactive participants2013-07-012,565
Total participants2013-07-012,565
2012: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2012 401k membership
Total participants, beginning-of-year2012-07-011,105
Total number of active participants reported on line 7a of the Form 55002012-07-011,293
Number of retired or separated participants receiving benefits2012-07-017
Total of all active and inactive participants2012-07-011,300
2011: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2011 401k membership
Total participants, beginning-of-year2011-07-01841
Total number of active participants reported on line 7a of the Form 55002011-07-011,105
Total of all active and inactive participants2011-07-011,105
Total participants2011-07-011,105
2010: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2010 401k membership
Total participants, beginning-of-year2010-07-01775
Total number of active participants reported on line 7a of the Form 55002010-07-01841
Total of all active and inactive participants2010-07-01841
Total participants2010-07-01841
2009: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2009 401k membership
Total participants, beginning-of-year2009-07-01690
Total number of active participants reported on line 7a of the Form 55002009-07-01775
Total of all active and inactive participants2009-07-01775
Total participants2009-07-01775
2007: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2007 401k membership
Total participants, beginning-of-year2007-07-010
Total number of active participants reported on line 7a of the Form 55002007-07-01759
Total of all active and inactive participants2007-07-01759

Form 5500 Responses for PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK

2022: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – General assets of the sponsorYes
2010-07-01Plan benefit arrangement – InsuranceYes
2009: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01This submission is the final filingNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes
2008: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 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
2007: PRE-TAX BENEFIT PLAN FOR EMPLOYEES OF THE BEHAVIORAL HEALTH NETWORK 2007 form 5500 responses
2007-07-01Type of plan entitySingle employer plan
2007-07-01First time form 5500 has been submittedYes
2007-07-01This submission is the final filingNo
2007-07-01Plan funding arrangement – InsuranceYes
2007-07-01Plan funding arrangement – General assets of the sponsorYes
2007-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550037
Policy instance 2
Insurance contract or identification number00550037
Number of Individuals Covered1005
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $19,933
Total amount of fees paid to insurance companyUSD $23,813
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,933
Amount paid for insurance broker fees23813
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered843
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $135,908
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $135,908
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550036
Policy instance 3
Insurance contract or identification number00550036
Number of Individuals Covered1657
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $7,231
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees7231
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550036
Policy instance 3
Insurance contract or identification number00550036
Number of Individuals Covered1573
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,900
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $197,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5900
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550037
Policy instance 2
Insurance contract or identification number00550037
Number of Individuals Covered1005
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $16,371
Total amount of fees paid to insurance companyUSD $19,532
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $722,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,371
Amount paid for insurance broker fees19532
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered870
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $192,089
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $192,089
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550037
Policy instance 2
Insurance contract or identification number00550037
Number of Individuals Covered873
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $11,336
Total amount of fees paid to insurance companyUSD $17,614
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $702,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,336
Amount paid for insurance broker fees17614
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered761
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $152,658
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $152,658
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550036
Policy instance 3
Insurance contract or identification number00550036
Number of Individuals Covered1416
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,691
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $210,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees5691
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550037
Policy instance 2
Insurance contract or identification number00550037
Number of Individuals Covered886
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $9,886
Total amount of fees paid to insurance companyUSD $15,540
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $735,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,886
Amount paid for insurance broker fees15540
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered740
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $174,167
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $174,167
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550036
Policy instance 3
Insurance contract or identification number00550036
Number of Individuals Covered1352
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $10,396
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $232,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees10396
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered724
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550037
Policy instance 2
Insurance contract or identification number00550037
Number of Individuals Covered891
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $6,826
Total amount of fees paid to insurance companyUSD $11,151
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $613,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,826
Amount paid for insurance broker fees11151
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550036
Policy instance 3
Insurance contract or identification number00550036
Number of Individuals Covered1378
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $6,103
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $172,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6103
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
Insurance broker organization code?3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered679
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0200173
Policy instance 4
Insurance contract or identification number0200173
Number of Individuals Covered1812
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $9,083
Total amount of fees paid to insurance companyUSD $48
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0200168
Policy instance 3
Insurance contract or identification number0200168
Number of Individuals Covered1812
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,375
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $635,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0161003
Policy instance 2
Insurance contract or identification number0161003
Number of Individuals Covered209
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK964603
Policy instance 8
Insurance contract or identification numberLK964603
Number of Individuals Covered988
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $4,542
Total amount of fees paid to insurance companyUSD $1,841
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,542
Amount paid for insurance broker fees1841
Additional information about fees paid to insurance brokerINCENTIVE BONUS PAYMENTS
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX966698
Policy instance 7
Insurance contract or identification numberFLX966698
Number of Individuals Covered1138
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $2,665
Total amount of fees paid to insurance companyUSD $1,012
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,665
Amount paid for insurance broker fees1012
Additional information about fees paid to insurance brokerINCENTIVE BONUS PAYMENTS
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0161003
Policy instance 6
Insurance contract or identification number0161003
Number of Individuals Covered115
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $776
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $38,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $776
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK-968220
Policy instance 5
Insurance contract or identification numberOK-968220
Number of Individuals Covered1138
Insurance policy start date2015-07-01
Insurance policy end date2016-07-01
Total amount of commissions paid to insurance brokerUSD $663
Total amount of fees paid to insurance companyUSD $134
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $6,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $663
Amount paid for insurance broker fees134
Additional information about fees paid to insurance brokerINCENTIVE BONUS PAYMENTS
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30019719
Policy instance 4
Insurance contract or identification number30019719
Number of Individuals Covered351
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $1,412
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $911
Insurance broker organization code?3
Insurance broker nameHUB INTERNATIONAL NEW ENGLAND LLC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3229192
Policy instance 3
Insurance contract or identification numberE3229192
Number of Individuals Covered131
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $15,444
Total amount of fees paid to insurance companyUSD $1,413
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $101,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,224
Amount paid for insurance broker fees147
Additional information about fees paid to insurance brokerSERVICE/ GENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameHABERMAN INSURANCE GROUP INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3337871
Policy instance 2
Insurance contract or identification number3337871
Number of Individuals Covered711
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $13,582
Total amount of fees paid to insurance companyUSD $1,000
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $346,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,582
Amount paid for insurance broker fees1000
Additional information about fees paid to insurance brokerSERVICE/ GENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered650
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $75,519
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,347,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75,519
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered489
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $140,734
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $140,734
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3337871
Policy instance 2
Insurance contract or identification number3337871
Number of Individuals Covered532
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $10,704
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $272,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,704
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 124111
Policy instance 4
Insurance contract or identification numberLTD 124111
Number of Individuals Covered743
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,667
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,667
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3229192
Policy instance 5
Insurance contract or identification numberE3229192
Number of Individuals Covered142
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $15,646
Total amount of fees paid to insurance companyUSD $1,710
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $99,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,641
Amount paid for insurance broker fees166
Additional information about fees paid to insurance brokerBONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?3
Insurance broker nameROBERT D. STEBBINS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30019719
Policy instance 6
Insurance contract or identification number30019719
Number of Individuals Covered241
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $1,132
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,132
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 151290
Policy instance 3
Insurance contract or identification numberGL 151290
Number of Individuals Covered841
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,810
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $44,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,810
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05983549
Policy instance 3
Insurance contract or identification numberTM05983549
Number of Individuals Covered1140
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $6,922
Total amount of fees paid to insurance companyUSD $3,220
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $289,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,922
Amount paid for insurance broker fees3220
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberLTD 124111
Policy instance 5
Insurance contract or identification numberLTD 124111
Number of Individuals Covered2565
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $3,693
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,693
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3229192
Policy instance 6
Insurance contract or identification numberE3229192
Number of Individuals Covered124
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $13,115
Total amount of fees paid to insurance companyUSD $1,839
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $91,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,792
Amount paid for insurance broker fees138
Additional information about fees paid to insurance brokerBONUSES AND NON-CASH INCENTIVES
Insurance broker organization code?3
Insurance broker nameFIELD EDDY & BULKLEY INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 151290
Policy instance 4
Insurance contract or identification numberGL 151290
Number of Individuals Covered1435
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,112
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $32,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,112
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30019719
Policy instance 2
Insurance contract or identification number30019719
Number of Individuals Covered205
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,019
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,019
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered486
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $99,606
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $99,606
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered466
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $117,869
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,521,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $117,869
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3229192
Policy instance 2
Insurance contract or identification numberE3229192
Number of Individuals Covered121
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $16,282
Total amount of fees paid to insurance companyUSD $1,977
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,703
Amount paid for insurance broker fees400
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTD INSURANCE INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05983549
Policy instance 4
Insurance contract or identification numberTM05983549
Number of Individuals Covered1293
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $13,716
Total amount of fees paid to insurance companyUSD $3,477
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $402,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,716
Amount paid for insurance broker fees3477
Additional information about fees paid to insurance brokerBASE COMMISSIONS
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30019719
Policy instance 3
Insurance contract or identification number30019719
Number of Individuals Covered158
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,130
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,130
Insurance broker organization code?3
Insurance broker nameDUKE INSURANCE BROKERAGE INC.
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered462
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $105,385
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,209,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3229192
Policy instance 2
Insurance contract or identification numberE3229192
Number of Individuals Covered128
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $16,920
Total amount of fees paid to insurance companyUSD $2,198
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30019719
Policy instance 3
Insurance contract or identification number30019719
Number of Individuals Covered134
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $975
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number148640 & 122168
Policy instance 5
Insurance contract or identification number148640 & 122168
Number of Individuals Covered696
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $7,961
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $90,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05983549
Policy instance 4
Insurance contract or identification numberTM05983549
Number of Individuals Covered1105
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $6,581
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $330,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number115744
Policy instance 1
Insurance contract or identification number115744
Number of Individuals Covered455
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $111,216
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,426,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00705
Policy instance 2
Insurance contract or identification numberMLN00705
Number of Individuals Covered668
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,792
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $27,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number000501
Policy instance 3
Insurance contract or identification number000501
Number of Individuals Covered841
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $7,361
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $318,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3229192
Policy instance 5
Insurance contract or identification numberE3229192
Number of Individuals Covered130
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $20,290
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )
Policy contract number30019719
Policy instance 6
Insurance contract or identification number30019719
Number of Individuals Covered92
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $756
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK961714
Policy instance 4
Insurance contract or identification numberLK961714
Number of Individuals Covered582
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,795
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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