401k Plan data: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN plan

BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 401k Plan overview

Plan Name	BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN
Plan identification number	501

BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN Benefits

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

401k Sponsoring company profile

BERKSHIRE COUNTY ARC, INC. has sponsored the creation of one or more 401k plans.

Company Name: BERKSHIRE COUNTY ARC, INC.

Employer identification number (EIN): 042218928

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2019-01-01
501 2018-01-01 KRISTI NASTARS
501 2018-01-01
501 2017-01-01 KRISTI NASTARS
501 2017-01-01 KRISTI NASTARS KENNETH W. SINGER 2018-06-18
501 2016-01-01 KRISTI NASTARS KENNETH W. SINGER 2017-05-15
501 2016-01-01
501 2015-01-01 MICHAEL J. CARITEY
501 2015-01-01 MICHAEL J. CARITEY KENNETH W. SINGER 2016-05-11
501 2014-01-01 MICHAEL J. CARITEY KENNETH W. SINGER 2015-06-08
501 2013-01-01 MICHAEL J. CARITEY KENNETH W. SINGER 2014-09-09
501 2012-01-01 MICHAEL J. CARITEY KENNETH W. SINGER 2014-09-09
501 2011-01-01 MICHAEL J CARITEY KENNETH W SINGER 2014-09-09
501 2010-01-01 MICHAEL CARITEY
501 2009-01-01 MICHAEL CARITEY
501 2008-03-01 MICHAEL CARITEY

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2019-01-01
501	2018-01-01	KRISTI NASTARS
501	2018-01-01
501	2017-01-01	KRISTI NASTARS
501	2017-01-01	KRISTI NASTARS	KENNETH W. SINGER	2018-06-18
501	2016-01-01	KRISTI NASTARS	KENNETH W. SINGER	2017-05-15
501	2016-01-01
501	2015-01-01	MICHAEL J. CARITEY
501	2015-01-01	MICHAEL J. CARITEY	KENNETH W. SINGER	2016-05-11
501	2014-01-01	MICHAEL J. CARITEY	KENNETH W. SINGER	2015-06-08
501	2013-01-01	MICHAEL J. CARITEY	KENNETH W. SINGER	2014-09-09
501	2012-01-01	MICHAEL J. CARITEY	KENNETH W. SINGER	2014-09-09
501	2011-01-01	MICHAEL J CARITEY	KENNETH W SINGER	2014-09-09
501	2010-01-01	MICHAEL CARITEY
501	2009-01-01	MICHAEL CARITEY
501	2008-03-01	MICHAEL CARITEY

Plan Statistics for BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN

401k plan membership statisitcs for BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN

Measure Date Value
2023: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 357
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 398
Total of all active and inactive participants 2023-01-01 398
Total participants 2023-01-01 398
2022: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 330
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 357
Total of all active and inactive participants 2022-01-01 357
Total participants 2022-01-01 357
2021: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 417
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 330
Total of all active and inactive participants 2021-01-01 330
Total participants 2021-01-01 330
2020: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 464
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 417
Total of all active and inactive participants 2020-01-01 417
Total participants 2020-01-01 417
2019: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 121
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 121
Total participants 2019-01-01 464
2018: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 155
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 155
Total participants 2018-01-01 405
2017: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 132
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 132
Total participants 2017-01-01 132
2016: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 425
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 425
Total of all active and inactive participants 2016-01-01 425
Total participants 2016-01-01 0
2015: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 115
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 115
Total participants 2015-01-01 115
2014: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 389
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 409
Total of all active and inactive participants 2014-01-01 409
Total participants 2014-01-01 0
2013: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 369
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 389
Total of all active and inactive participants 2013-01-01 389
Total participants 2013-01-01 0
2012: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 355
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 369
Total of all active and inactive participants 2012-01-01 369
Total participants 2012-01-01 0
2011: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 315
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 355
Total of all active and inactive participants 2011-01-01 355
Total participants 2011-01-01 355
2010: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 294
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 315
Total of all active and inactive participants 2010-01-01 315
Total participants 2010-01-01 315
2009: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 302
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 294
Total of all active and inactive participants 2009-01-01 294
Total participants 2009-01-01 294
2008: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2008 401k membership
Total participants, beginning-of-year 2008-03-01 325
Total number of active participants reported on line 7a of the Form 5500 2008-03-01 302
Total of all active and inactive participants 2008-03-01 302
Total participants 2008-03-01 302

Measure	Date	Value
2023: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	357
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	398
Total of all active and inactive participants	2023-01-01	398
Total participants	2023-01-01	398
2022: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	330
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	357
Total of all active and inactive participants	2022-01-01	357
Total participants	2022-01-01	357
2021: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	417
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	330
Total of all active and inactive participants	2021-01-01	330
Total participants	2021-01-01	330
2020: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	464
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	417
Total of all active and inactive participants	2020-01-01	417
Total participants	2020-01-01	417
2019: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	121
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	121
Total participants	2019-01-01	464
2018: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	155
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	155
Total participants	2018-01-01	405
2017: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	132
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	132
Total participants	2017-01-01	132
2016: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	425
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	425
Total of all active and inactive participants	2016-01-01	425
Total participants	2016-01-01	0
2015: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	115
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	115
Total participants	2015-01-01	115
2014: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	389
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	409
Total of all active and inactive participants	2014-01-01	409
Total participants	2014-01-01	0
2013: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	369
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	389
Total of all active and inactive participants	2013-01-01	389
Total participants	2013-01-01	0
2012: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	355
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	369
Total of all active and inactive participants	2012-01-01	369
Total participants	2012-01-01	0
2011: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	315
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	355
Total of all active and inactive participants	2011-01-01	355
Total participants	2011-01-01	355
2010: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	294
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	315
Total of all active and inactive participants	2010-01-01	315
Total participants	2010-01-01	315
2009: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	302
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	294
Total of all active and inactive participants	2009-01-01	294
Total participants	2009-01-01	294
2008: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2008 401k membership
Total participants, beginning-of-year	2008-03-01	325
Total number of active participants reported on line 7a of the Form 5500	2008-03-01	302
Total of all active and inactive participants	2008-03-01	302
Total participants	2008-03-01	302

Form 5500 Responses for BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN

2023: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2008: BERKSHIRE COUNTY ARC SECTION 125 CAFETERIA PLAN 2008 form 5500 responses
2008-03-01	Type of plan entity	Single employer plan
2008-03-01	Submission has been amended	No
2008-03-01	This submission is the final filing	No
2008-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2008-03-01	Plan is a collectively bargained plan	No
2008-03-01	Plan funding arrangement – Insurance	Yes
2008-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30022709

Policy instance

Insurance contract or identification number	30022709
Number of Individuals Covered	221
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,363
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,951
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 number

LK 0752735

Policy instance

Insurance contract or identification number	LK 0752735
Number of Individuals Covered	143
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,812
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,082
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 number

FLX 0966464

Policy instance

Insurance contract or identification number	FLX 0966464
Number of Individuals Covered	278
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,549
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,278
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 number

LK 0964425

Policy instance

Insurance contract or identification number	LK 0964425
Number of Individuals Covered	398
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $7,115
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	250
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,851
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $144,654
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 number

OK 0967992

Policy instance

Insurance contract or identification number	OK 0967992
Number of Individuals Covered	278
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $134
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,115
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 number

117939

Policy instance

Insurance contract or identification number	117939
Number of Individuals Covered	280
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $73,471
Welfare Benefit Premiums Paid to Carrier	USD $3,489,272
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 number

LK752735

Policy instance

Insurance contract or identification number	LK752735
Number of Individuals Covered	85
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,642
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,642

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966464

Policy instance

Insurance contract or identification number	FLX966464
Number of Individuals Covered	261
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,520
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,520

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964425

Policy instance

Insurance contract or identification number	LK 964425
Number of Individuals Covered	357
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,614
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,614

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	255
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,032
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,032

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967992

Policy instance

Insurance contract or identification number	OK 967992
Number of Individuals Covered	261
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $138
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $138

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

117939

Policy instance

Insurance contract or identification number	117939
Number of Individuals Covered	258
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $80,679
Welfare Benefit Premiums Paid to Carrier	USD $3,604,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,679

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30022709

Policy instance

Insurance contract or identification number	30022709
Number of Individuals Covered	210
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,396
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,396

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK752735

Policy instance

Insurance contract or identification number	LK752735
Number of Individuals Covered	75
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $823
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $823

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966464

Policy instance

Insurance contract or identification number	FLX966464
Number of Individuals Covered	256
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,776
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,776

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964425

Policy instance

Insurance contract or identification number	LK 964425
Number of Individuals Covered	330
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,621
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,621

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	254
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,994
Total amount of fees paid to insurance company	USD $267
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $151,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,994
Amount paid for insurance broker fees	267
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967992

Policy instance

Insurance contract or identification number	OK 967992
Number of Individuals Covered	256
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $138
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $138

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

117939

Policy instance

Insurance contract or identification number	117939
Number of Individuals Covered	278
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $100,495
Welfare Benefit Premiums Paid to Carrier	USD $3,719,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $100,495

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30022709

Policy instance

Insurance contract or identification number	30022709
Number of Individuals Covered	211
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,492
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,492

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT961761

Policy instance

Insurance contract or identification number	VDT961761
Number of Individuals Covered	325
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,213
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $152,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,213

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966464

Policy instance

Insurance contract or identification number	FLX966464
Number of Individuals Covered	326
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,628
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,628

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964425

Policy instance

Insurance contract or identification number	LK 964425
Number of Individuals Covered	426
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,591
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,591

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	259
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,763
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,763

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967992

Policy instance

Insurance contract or identification number	OK 967992
Number of Individuals Covered	124
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $167
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $167

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

117939

Policy instance

Insurance contract or identification number	117939
Number of Individuals Covered	290
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $107,385
Welfare Benefit Premiums Paid to Carrier	USD $3,664,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,385

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT961761

Policy instance

Insurance contract or identification number	VDT961761
Number of Individuals Covered	345
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,275
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,850

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966464

Policy instance

Insurance contract or identification number	FLX966464
Number of Individuals Covered	356
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,782
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,698

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964425

Policy instance

Insurance contract or identification number	LK 964425
Number of Individuals Covered	464
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,705
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,620

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	283
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,282
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $166,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,282

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967992

Policy instance

Insurance contract or identification number	OK 967992
Number of Individuals Covered	355
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $181
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $112

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

117939

Policy instance

Insurance contract or identification number	117939
Number of Individuals Covered	290
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $90,243
Welfare Benefit Premiums Paid to Carrier	USD $3,681,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,066

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT961761

Policy instance

Insurance contract or identification number	VDT961761
Number of Individuals Covered	326
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,886
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,886

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966464

Policy instance

Insurance contract or identification number	FLX966464
Number of Individuals Covered	374
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,323
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,323

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964425

Policy instance

Insurance contract or identification number	LK 964425
Number of Individuals Covered	405
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,446
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,446

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	472
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $85,673
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $631,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $85,673

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967992

Policy instance

Insurance contract or identification number	OK 967992
Number of Individuals Covered	329
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $151
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $151

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 967992

Policy instance

Insurance contract or identification number	OK 967992
Number of Individuals Covered	377
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $176
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $1,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $176
Insurance broker name	GREYLOCK INSURANCE AGENCY

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	482
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $87,610
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $600,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,610
Insurance broker name	GREYLOCK INSURANCE AGENCY

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964425

Policy instance

Insurance contract or identification number	LK 964425
Number of Individuals Covered	435
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,977
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,977
Insurance broker name	GREYLOCK INSURANCE AGENCY

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX966464

Policy instance

Insurance contract or identification number	FLX966464
Number of Individuals Covered	418
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,028
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,028
Insurance broker name	GREYLOCK INSURANCE AGENCY

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT961761

Policy instance

Insurance contract or identification number	VDT961761
Number of Individuals Covered	381
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,204
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,204
Insurance broker name	GREYLOCK INSURANCE AGENCY

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3337639

Policy instance

Insurance contract or identification number	3337639
Number of Individuals Covered	282
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,741
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,741
Insurance broker name	GREYLOCK FINANCIAL AND INSURANCE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

LTD 654112

Policy instance

Insurance contract or identification number	LTD 654112
Number of Individuals Covered	400
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,829
Total amount of fees paid to insurance company	USD $1,180
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,829
Amount paid for insurance broker fees	833
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker name	NFP INSURANCE SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

GL 652110

Policy instance

Insurance contract or identification number	GL 652110
Number of Individuals Covered	341
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,193
Total amount of fees paid to insurance company	USD $1,558
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,193
Amount paid for insurance broker fees	1100
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker name	NFP INSURANCE SERVICES INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

G656305

Policy instance

Insurance contract or identification number	G656305
Number of Individuals Covered	339
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $75
Total amount of fees paid to insurance company	USD $3,226
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $118,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75
Amount paid for insurance broker fees	2277
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker name	NFP INSURANCE SERVICES INC

FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )

Policy contract number

C004511535C01

Policy instance

Insurance contract or identification number	C004511535C01
Number of Individuals Covered	465
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $41,200
Welfare Benefit Premiums Paid to Carrier	USD $2,311,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,200
Insurance broker name	GREYLOCK INSURANCE AGENCY

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )

Policy contract number

30022709

Policy instance

Insurance contract or identification number	30022709
Number of Individuals Covered	162
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,138
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,138
Insurance broker name	GREYLOCK FINANCIAL AND INSURANCE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

LTD 654112

Policy instance

Insurance contract or identification number	LTD 654112
Number of Individuals Covered	389
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,126
Total amount of fees paid to insurance company	USD $442
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,126
Amount paid for insurance broker fees	442
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker name	AMERICAN BENEFITS GROUP

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

GL 652110

Policy instance

Insurance contract or identification number	GL 652110
Number of Individuals Covered	330
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,270
Total amount of fees paid to insurance company	USD $610
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,270
Amount paid for insurance broker fees	610
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker name	AMERICAN BENEFITS COMPANY

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

G656305

Policy instance

Insurance contract or identification number	G656305
Number of Individuals Covered	329
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $75,906
Total amount of fees paid to insurance company	USD $1,279
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75,906
Amount paid for insurance broker fees	1279
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Insurance broker name	AMERICAN BENEFITS GROUP

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115277

Policy instance

Insurance contract or identification number	115277
Number of Individuals Covered	291
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $81,129
Welfare Benefit Premiums Paid to Carrier	USD $2,184,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,129
Insurance broker name	GREYLOCK INSURANCE AGENCY

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

5620003

Policy instance

Insurance contract or identification number	5620003
Number of Individuals Covered	429
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,748
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,748
Insurance broker name	GREYLOCK FINANCIAL AND INSURANCE

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )

Policy contract number

30022709

Policy instance

Insurance contract or identification number	30022709
Number of Individuals Covered	143
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,038
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,038
Insurance broker name	GREYLOCK FINANCIAL AND INSURANCE

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

G656305

Policy instance

Insurance contract or identification number	G656305
Number of Individuals Covered	313
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,945
Total amount of fees paid to insurance company	USD $830
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $102,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	830
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Commission paid to Insurance Broker	USD $4,945
Insurance broker name	AMERICAN BENEFITS GROUP

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115277

Policy instance

Insurance contract or identification number	115277
Number of Individuals Covered	281
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $62,842
Welfare Benefit Premiums Paid to Carrier	USD $2,106,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,842
Insurance broker name	GREYLOCK INSURANCE AGENCY

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

GL 652110

Policy instance

Insurance contract or identification number	GL 652110
Number of Individuals Covered	315
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,249
Total amount of fees paid to insurance company	USD $466
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	466
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Commission paid to Insurance Broker	USD $3,249
Insurance broker name	AMERICAN BENEFITS COMPANY

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

LTD 654112

Policy instance

Insurance contract or identification number	LTD 654112
Number of Individuals Covered	369
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,129
Total amount of fees paid to insurance company	USD $277
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	277
Additional information about fees paid to insurance broker	ADMINISTRATIVE AND OTHER
Commission paid to Insurance Broker	USD $4,129
Insurance broker name	AMERICAN BENEFITS GROUP

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )

Policy contract number

30022709

Policy instance

Insurance contract or identification number	30022709
Number of Individuals Covered	134
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,110
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,110
Insurance broker name	GREYLOCK FINANCIAL AND INSURANCE

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )

Policy contract number

5620003

Policy instance

Insurance contract or identification number	5620003
Number of Individuals Covered	403
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,441
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,441
Insurance broker name	GREYLOCK FINANCIAL AND INSURANCE

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47093 )

Policy contract number

30022709

Policy instance

Insurance contract or identification number	30022709
Number of Individuals Covered	129
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,102
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,899
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 number

5620003

Policy instance

Insurance contract or identification number	5620003
Number of Individuals Covered	382
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,894
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,350
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: 68384 )

Policy contract number

LTD 654112

Policy instance

Insurance contract or identification number	LTD 654112
Number of Individuals Covered	355
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,930
Total amount of fees paid to insurance company	USD $419
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,800
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: 68384 )

Policy contract number

GL 652110

Policy instance

Insurance contract or identification number	GL 652110
Number of Individuals Covered	298
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,516
Total amount of fees paid to insurance company	USD $793
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,658
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: 68384 )

Policy contract number

G656305

Policy instance

Insurance contract or identification number	G656305
Number of Individuals Covered	297
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,853
Total amount of fees paid to insurance company	USD $1,373
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,319
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 number

115277

Policy instance

Insurance contract or identification number	115277
Number of Individuals Covered	266
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $101,396
Welfare Benefit Premiums Paid to Carrier	USD $1,999,620
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 number

115277

Policy instance

Insurance contract or identification number	115277
Number of Individuals Covered	266
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $80,295
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,930,038
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: 68384 )

Policy contract number

G656305

Policy instance

Insurance contract or identification number	G656305
Number of Individuals Covered	298
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,029
Total amount of fees paid to insurance company	USD $2,496
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $82,853
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: 68384 )

Policy contract number

GL 652110

Policy instance

Insurance contract or identification number	GL 652110
Number of Individuals Covered	292
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,949
Total amount of fees paid to insurance company	USD $1,543
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $47,493
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: 68384 )

Policy contract number

LTD 654112

Policy instance

Insurance contract or identification number	LTD 654112
Number of Individuals Covered	315
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,344
Total amount of fees paid to insurance company	USD $707
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $25,946
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 number

5620003

Policy instance

Insurance contract or identification number	5620003
Number of Individuals Covered	395
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,957
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $126,272
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: 68384 )

Policy contract number

GL 652110

Policy instance

Insurance contract or identification number	GL 652110
Number of Individuals Covered	295
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $2,502
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $36,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,502
Insurance broker name	AMERICAN BENEFITS GROUP

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115277

Policy instance

Insurance contract or identification number	115277
Number of Individuals Covered	254
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $70,558
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,816,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,558
Insurance broker name	GREYLOCK INSURANCE AGENCY

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

LTD 654112

Policy instance

Insurance contract or identification number	LTD 654112
Number of Individuals Covered	294
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $2,412
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $16,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,412
Insurance broker name	AMERICAN BENEFITS GROUP

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00431511

Policy instance

Insurance contract or identification number	00431511
Number of Individuals Covered	230
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $3,161
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $118,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,161
Insurance broker name	GREYLOCK INSURANCE AGENCY

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68384 )

Policy contract number

G656305

Policy instance

Insurance contract or identification number	G656305
Number of Individuals Covered	297
Insurance policy start date	2009-01-01
Insurance policy end date	2009-12-31
Total amount of commissions paid to insurance broker	USD $3,787
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $58,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,787
Insurance broker name	AMERICAN BENEFITS GROUP

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

120240

Policy instance

Insurance contract or identification number	120240
Number of Individuals Covered	115
Insurance policy start date	2008-07-01
Insurance policy end date	2009-01-01
Total amount of commissions paid to insurance broker	USD $2,607
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $16,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,607
Insurance broker name	AMERICAN BENEFITS INSURANCE CO

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

120241

Policy instance

Insurance contract or identification number	120241
Number of Individuals Covered	598
Insurance policy start date	2008-07-01
Insurance policy end date	2009-01-01
Total amount of commissions paid to insurance broker	USD $3,130
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $46,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,130
Insurance broker name	AMERICAN BENEFITS INSURANCE CO

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00431511

Policy instance

Insurance contract or identification number	00431511
Number of Individuals Covered	223
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $1,098
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $116,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,098
Insurance broker name	GREYLOCK INSURANCE AGENCY

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115277

Policy instance

Insurance contract or identification number	115277
Number of Individuals Covered	246
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $29,599
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,715,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,599
Insurance broker name	GREYLOCK INSURANCE AGENCY

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BERKSHIRE COUNTY HEAD START CHILD DEVELOPMENT PROGRAM, INC. PENSION PLAN [EIN = 042578986]

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Company Name:	BERKSHIRE COUNTY ARC, INC.
Employer identification number (EIN):	042218928
NAIC Classification:	624100
NAIC Description:	Individual and Family Services