401k Plan data: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN plan

EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 401k Plan overview

Plan Name	EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN
Plan identification number	501

EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

EASTERN BEARINGS, INC. D/B/A EASTERN INDUSTRIAL AUTOMATION has sponsored the creation of one or more 401k plans.

Company Name: EASTERN BEARINGS, INC. D/B/A EASTERN INDUSTRIAL AUTOMATION

Employer identification number (EIN): 042316388

NAIC Classification: 423800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01 JEFFREY HIRSHBERG
501 2017-01-01 JEFFREY R. HIRSHBERG
501 2016-01-01 JEFFREY R. HIRSHBERG
501 2015-01-01 JEFFREY R. HIRSHBERG
501 2014-01-01 JEFFREY HIRSHBERG
501 2013-01-01 JEFFREY R. HIRSHBERG
501 2012-01-01 JEFFREY R. HIRSHBERG
501 2009-01-01 JEFFREY R. HIRSHBERG

Plan Statistics for EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN

401k plan membership statisitcs for EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN

Measure Date Value
2022: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 123
Total of all active and inactive participants 2022-01-01 123
2021: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 119
Total of all active and inactive participants 2021-01-01 119
2020: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 141
Total of all active and inactive participants 2020-01-01 141
2019: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 132
Total of all active and inactive participants 2019-01-01 132
2018: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 122
Total of all active and inactive participants 2018-01-01 122
2017: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 124
Total of all active and inactive participants 2017-01-01 124
2016: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 120
Total of all active and inactive participants 2016-01-01 120
2015: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 119
Total of all active and inactive participants 2015-01-01 119
2014: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 115
Total of all active and inactive participants 2014-01-01 115
2013: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 104
Total of all active and inactive participants 2013-01-01 104
2012: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 102
Total of all active and inactive participants 2012-01-01 102
2009: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 89
Total of all active and inactive participants 2009-01-01 89
Total participants 2009-01-01 89

Measure	Date	Value
2022: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	123
Total of all active and inactive participants	2022-01-01	123
2021: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	119
Total of all active and inactive participants	2021-01-01	119
2020: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	141
Total of all active and inactive participants	2020-01-01	141
2019: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	132
Total of all active and inactive participants	2019-01-01	132
2018: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	122
Total of all active and inactive participants	2018-01-01	122
2017: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	124
Total of all active and inactive participants	2017-01-01	124
2016: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	120
Total of all active and inactive participants	2016-01-01	120
2015: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	119
Total of all active and inactive participants	2015-01-01	119
2014: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	115
Total of all active and inactive participants	2014-01-01	115
2013: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	104
Total of all active and inactive participants	2013-01-01	104
2012: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	102
Total of all active and inactive participants	2012-01-01	102
2009: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	89
Total of all active and inactive participants	2009-01-01	89
Total participants	2009-01-01	89

Form 5500 Responses for EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN

2022: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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 benefit arrangement – Insurance	Yes
2018: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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 benefit arrangement – Insurance	Yes
2017: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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 benefit arrangement – Insurance	Yes
2016: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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 benefit arrangement – Insurance	Yes
2015: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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: EASTERN BEARINGS, INC. PREMIUM CONVERSION 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
2009: EASTERN BEARINGS, INC. PREMIUM CONVERSION PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	116
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $100,389
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,500,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $100,389
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	121
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $4,873
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $128,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,873
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	121
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $97,394
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,400,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $97,394
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	126
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $5,285
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $141,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,285
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	113
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $88,352
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,203,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,352
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	118
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $5,267
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $147,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,267
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	110
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $5,096
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,096
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	108
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $78,280
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,965,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $78,280
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	109
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $76,619
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,910,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $76,619
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	110
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $5,013
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $135,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,013
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	110
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Total amount of commissions paid to insurance broker	USD $5,069
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,069
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78342000

Policy instance

Insurance contract or identification number	78342000
Number of Individuals Covered	62
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Total amount of commissions paid to insurance broker	USD $20,208
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $495,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,208
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45501000

Policy instance

Insurance contract or identification number	45501000
Number of Individuals Covered	177
Insurance policy start date	2016-04-01
Insurance policy end date	2017-03-31
Total amount of commissions paid to insurance broker	USD $53,058
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,338,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,058
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	103
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $4,819
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $118,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,819
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78342000

Policy instance

Insurance contract or identification number	78342000
Number of Individuals Covered	61
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $16,081
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $406,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,081
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 )

Policy contract number

45501000

Policy instance

Insurance contract or identification number	45501000
Number of Individuals Covered	171
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $44,248
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,116,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,248
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	94
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $4,721
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $113,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,721
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78342000

Policy instance

Insurance contract or identification number	78342000
Number of Individuals Covered	26
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $14,625
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $371,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,625
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

45501000

Policy instance

Insurance contract or identification number	45501000
Number of Individuals Covered	65
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $42,188
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,058,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,188
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

45501000

Policy instance

Insurance contract or identification number	45501000
Number of Individuals Covered	67
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $37,459
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $939,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,459
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78342000

Policy instance

Insurance contract or identification number	78342000
Number of Individuals Covered	24
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $12,850
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $317,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,850
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	93
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $4,786
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,786
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4025669

Policy instance

Insurance contract or identification number	4025669
Number of Individuals Covered	90
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $4,580
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $106,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,580
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

78342000

Policy instance

Insurance contract or identification number	78342000
Number of Individuals Covered	26
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $12,630
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $293,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,630
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )

Policy contract number

45501000

Policy instance

Insurance contract or identification number	45501000
Number of Individuals Covered	64
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $29,265
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $773,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,265
Insurance broker organization code?	3
Insurance broker name	UCN INSURANCE SERVICES LLC

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Company Name:	EASTERN BEARINGS, INC. D/B/A EASTERN INDUSTRIAL AUTOMATION
Employer identification number (EIN):	042316388
NAIC Classification:	423800