QUINCY COMMUNITY ACTION PROGRAMS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN
401k plan membership statisitcs for QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN
| Measure | Date | Value |
|---|
| 2022: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-10-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-10-01 | 114 |
| Number of retired or separated participants receiving benefits | 2022-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-10-01 | 0 |
| Total of all active and inactive participants | 2022-10-01 | 114 |
| Number of employers contributing to the scheme | 2022-10-01 | 0 |
| 2021: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-10-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 108 |
| Number of retired or separated participants receiving benefits | 2021-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
| Total of all active and inactive participants | 2021-10-01 | 108 |
| Number of employers contributing to the scheme | 2021-10-01 | 0 |
| 2020: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 113 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
| Total of all active and inactive participants | 2020-10-01 | 113 |
| Number of employers contributing to the scheme | 2020-10-01 | 0 |
| 2019: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 108 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
| Total of all active and inactive participants | 2019-10-01 | 108 |
| Number of employers contributing to the scheme | 2019-10-01 | 0 |
| 2018: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 107 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
| Total of all active and inactive participants | 2018-10-01 | 107 |
| Number of employers contributing to the scheme | 2018-10-01 | 0 |
| 2017: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 114 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 114 |
| Number of employers contributing to the scheme | 2017-10-01 | 0 |
| 2016: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 112 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 112 |
| 2015: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 112 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 112 |
| 2014: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 115 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
| Total of all active and inactive participants | 2014-10-01 | 115 |
| 2013: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 117 |
| Total of all active and inactive participants | 2013-10-01 | 117 |
| 2012: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 116 |
| Total of all active and inactive participants | 2012-10-01 | 116 |
| 2011: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 113 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 0 |
| Total of all active and inactive participants | 2011-10-01 | 113 |
| 2009: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 124 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 0 |
| Total of all active and inactive participants | 2009-10-01 | 124 |
| 2022: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2022 form 5500 responses |
|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2021 form 5500 responses |
|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Submission has been amended | No |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: QUINCY COMMUNITY ACTION PROGRAMS GROUP LIFE AD&D SHORT-TERM DISABILITY AND LONG-TERM DISABILITY PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Submission has been amended | No |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | No |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AMI2 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AMI2 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $6,303 | | Total amount of fees paid to insurance company | USD $3,113 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $50,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,303 | | Amount paid for insurance broker fees | 3113 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| NEIGHBORHOOD HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 11109 ) |
| Policy contract number | SXA/ARAC 100872 |
| Policy instance | 2 |
| Insurance contract or identification number | SXA/ARAC 100872 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $26,903 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $780,601 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $26,903 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 6504-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 6504-1 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $4,309 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,309 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 65041 |
| Policy instance | 1 |
| Insurance contract or identification number | 65041 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $4,289 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,289 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
| Policy contract number | 1085570000 |
| Policy instance | 3 |
| Insurance contract or identification number | 1085570000 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $30,794 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $956,390 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $30,794 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AMI2 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0AMI2 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $6,181 | | Total amount of fees paid to insurance company | USD $2,977 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $49,868 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,181 | | Amount paid for insurance broker fees | 2977 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 65041 |
| Policy instance | 1 |
| Insurance contract or identification number | 65041 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $4,106 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,106 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 ) |
| Policy contract number | 1085570000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1085570000 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $32,859 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $873,813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $32,859 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AMI2 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AMI2 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $5,955 | | Total amount of fees paid to insurance company | USD $3,663 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $47,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,955 | | Amount paid for insurance broker fees | 3663 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AMI2 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AMI2 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $7,132 | | Total amount of fees paid to insurance company | USD $1,865 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $65,625 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,132 | | Amount paid for insurance broker fees | 1865 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 65041 |
| Policy instance | 2 |
| Insurance contract or identification number | 65041 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $3,929 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,725 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,929 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| NEIGHBORHOOD HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 11109 ) |
| Policy contract number | PN3 |
| Policy instance | 1 |
| Insurance contract or identification number | PN3 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $24,778 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $719,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $24,778 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AMI2 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AMI2 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $6,702 | | Total amount of fees paid to insurance company | USD $2,826 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $61,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,702 | | Amount paid for insurance broker fees | 2826 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 65041 |
| Policy instance | 2 |
| Insurance contract or identification number | 65041 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $4,048 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,048 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| NEIGHBORHOOD HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 11109 ) |
| Policy contract number | PN3 |
| Policy instance | 1 |
| Insurance contract or identification number | PN3 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $31,506 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $651,044 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,506 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AMI2 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG0AMI2 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $6,886 | | Total amount of fees paid to insurance company | USD $3,014 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $64,481 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C004509636C01 |
| Policy instance | 2 |
| Insurance contract or identification number | C004509636C01 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $21,230 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $807,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 65041 |
| Policy instance | 1 |
| Insurance contract or identification number | 65041 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $4,210 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C004509636C01 |
| Policy instance | 1 |
| Insurance contract or identification number | C004509636C01 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $19,261 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $732,159 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,261 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP, LLC |
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| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 6504_1 |
| Policy instance | 2 |
| Insurance contract or identification number | 6504_1 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $4,635 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,635 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AMI2 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AMI2 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $5,794 | | Total amount of fees paid to insurance company | USD $1,090 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT AND VOLUNTARY LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $56,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,794 | | Amount paid for insurance broker fees | 1090 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
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| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | C004509636C01 |
| Policy instance | 4 |
| Insurance contract or identification number | C004509636C01 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $1,429 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $61,757 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,429 | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AMI2 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AMI2 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $5,650 | | Total amount of fees paid to insurance company | USD $2,242 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT AND VOLUNTARY LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $48,638 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,650 | | Amount paid for insurance broker fees | 2242 | | Additional information about fees paid to insurance broker | OTHER SERVICE FEES AND OTHER COMMISSIONS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
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| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) |
| Policy contract number | 6504_1 |
| Policy instance | 2 |
| Insurance contract or identification number | 6504_1 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $4,544 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,544 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | NO OTHER COMMISSIONS OR FEES PAID | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP |
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| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | C004509636C01 |
| Policy instance | 1 |
| Insurance contract or identification number | C004509636C01 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $26,897 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $804,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,897 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | NO FEES OR OTHER COMMISSIONS PAID | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP, LLC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AMI2 |
| Policy instance | 1 |
| Insurance contract or identification number | G000AMI2 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $5,596 | | Total amount of fees paid to insurance company | USD $279 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT AND VOLUNTARY LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $48,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,596 | | Amount paid for insurance broker fees | 279 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | EASTERN INSURANCE GROUP LLC |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 079681 |
| Policy instance | 1 |
| Insurance contract or identification number | 079681 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $5,817 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $64,395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 079681 |
| Policy instance | 1 |
| Insurance contract or identification number | 079681 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $6,363 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $72,134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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