THOMAS H LEE MANAGEMENT CO, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA
401k plan membership statisitcs for THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA
| Measure | Date | Value |
|---|
| 2023: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-06-01 | 166 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-06-01 | 165 |
| Number of retired or separated participants receiving benefits | 2023-06-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2023-06-01 | 0 |
| Total of all active and inactive participants | 2023-06-01 | 167 |
| 2022: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-06-01 | 143 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 164 |
| Number of retired or separated participants receiving benefits | 2022-06-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 0 |
| Total of all active and inactive participants | 2022-06-01 | 166 |
| 2021: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-06-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 141 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
| Total of all active and inactive participants | 2021-06-01 | 143 |
| 2020: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 130 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
| Total of all active and inactive participants | 2020-06-01 | 135 |
| 2019: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 123 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
| Total of all active and inactive participants | 2019-06-01 | 128 |
| 2018: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 113 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 120 |
| 2017: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 108 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 6 |
| Total of all active and inactive participants | 2017-06-01 | 114 |
| 2016: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 167 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 101 |
| Total of all active and inactive participants | 2016-06-01 | 101 |
| 2015: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 161 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 167 |
| Total of all active and inactive participants | 2015-06-01 | 167 |
| 2014: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 161 |
| Total of all active and inactive participants | 2014-06-01 | 161 |
| 2013: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 162 |
| Total of all active and inactive participants | 2013-06-01 | 162 |
| 2012: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 162 |
| Number of retired or separated participants receiving benefits | 2012-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-06-01 | 0 |
| Total of all active and inactive participants | 2012-06-01 | 162 |
| 2011: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 134 |
| Number of retired or separated participants receiving benefits | 2011-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-06-01 | 0 |
| Total of all active and inactive participants | 2011-06-01 | 134 |
| 2009: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 109 |
| Number of retired or separated participants receiving benefits | 2009-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-06-01 | 0 |
| Total of all active and inactive participants | 2009-06-01 | 109 |
| Measure | Date | Value |
|---|
| 2018 : THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2018 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-05-31 | No |
| Was this plan covered by a fidelity bond | 2018-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2018-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-05-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-05-31 | No |
| Did the plan have assets held for investment | 2018-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-05-31 | No |
| 2017 : THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2017 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-05-31 | No |
| Was this plan covered by a fidelity bond | 2017-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2017-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-05-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-05-31 | No |
| Did the plan have assets held for investment | 2017-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-05-31 | No |
| 2016 : THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2016 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-05-31 | No |
| Was this plan covered by a fidelity bond | 2016-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-05-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-05-31 | No |
| Did the plan have assets held for investment | 2016-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-05-31 | No |
| 2015 : THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2015 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | No |
| Was this plan covered by a fidelity bond | 2015-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2015-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-05-31 | No |
| Did the plan have assets held for investment | 2015-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | No |
| 2014 : THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2014 401k financial data |
|---|
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-05-31 | No |
| Was this plan covered by a fidelity bond | 2014-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2014-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-05-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-05-31 | No |
| Did the plan have assets held for investment | 2014-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-05-31 | No |
| 2023: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2023 form 5500 responses |
|---|
| 2023-06-01 | Type of plan entity | Single employer plan |
| 2023-06-01 | Submission has been amended | No |
| 2023-06-01 | This submission is the final filing | No |
| 2023-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-06-01 | Plan is a collectively bargained plan | No |
| 2023-06-01 | Plan funding arrangement – Insurance | Yes |
| 2023-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2022 form 5500 responses |
|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | Submission has been amended | No |
| 2022-06-01 | This submission is the final filing | No |
| 2022-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-06-01 | Plan is a collectively bargained plan | No |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2021 form 5500 responses |
|---|
| 2021-06-01 | Type of plan entity | Single employer plan |
| 2021-06-01 | Submission has been amended | No |
| 2021-06-01 | This submission is the final filing | No |
| 2021-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-06-01 | Plan is a collectively bargained plan | No |
| 2021-06-01 | Plan funding arrangement – Insurance | Yes |
| 2021-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2020 form 5500 responses |
|---|
| 2020-06-01 | Type of plan entity | Single employer plan |
| 2020-06-01 | Submission has been amended | No |
| 2020-06-01 | This submission is the final filing | No |
| 2020-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-06-01 | Plan is a collectively bargained plan | No |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2019 form 5500 responses |
|---|
| 2019-06-01 | Type of plan entity | Single employer plan |
| 2019-06-01 | Submission has been amended | No |
| 2019-06-01 | This submission is the final filing | No |
| 2019-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-06-01 | Plan is a collectively bargained plan | No |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2018 form 5500 responses |
|---|
| 2018-06-01 | Type of plan entity | Single employer plan |
| 2018-06-01 | Submission has been amended | No |
| 2018-06-01 | This submission is the final filing | No |
| 2018-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-06-01 | Plan is a collectively bargained plan | No |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2017 form 5500 responses |
|---|
| 2017-06-01 | Type of plan entity | Single employer plan |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2016 form 5500 responses |
|---|
| 2016-06-01 | Type of plan entity | Single employer plan |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2015 form 5500 responses |
|---|
| 2015-06-01 | Type of plan entity | Single employer plan |
| 2015-06-01 | Plan funding arrangement – Insurance | Yes |
| 2015-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2014 form 5500 responses |
|---|
| 2014-06-01 | Type of plan entity | Single employer plan |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Single employer plan |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Single employer plan |
| 2012-06-01 | Submission has been amended | No |
| 2012-06-01 | This submission is the final filing | No |
| 2012-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-06-01 | Plan is a collectively bargained plan | No |
| 2012-06-01 | Plan funding arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2011 form 5500 responses |
|---|
| 2011-06-01 | Type of plan entity | Single employer plan |
| 2011-06-01 | Submission has been amended | No |
| 2011-06-01 | This submission is the final filing | No |
| 2011-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-06-01 | Plan is a collectively bargained plan | No |
| 2011-06-01 | Plan funding arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: THOMAS H LEE MANAGEMENT CO, LLC GROUP BENEFITS PLA 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Single employer plan |
| 2009-06-01 | Submission has been amended | No |
| 2009-06-01 | This submission is the final filing | No |
| 2009-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-06-01 | Plan is a collectively bargained plan | No |
| 2009-06-01 | Plan funding arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 4 |
| Insurance contract or identification number | 0206540 | | Number of Individuals Covered | 411 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $6,756 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99139061001 |
| Policy instance | 3 |
| Insurance contract or identification number | 99139061001 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $1,669 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 | Yes | | 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 $18,292 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| Insurance contract or identification number | 0206540 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $43,984 | | Total amount of fees paid to insurance company | USD $14,751 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 | 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 | | 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 $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| Insurance contract or identification number | 07091 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2023-06-01 | | Insurance policy end date | 2024-05-31 | | Total amount of commissions paid to insurance broker | USD $28,808 | | Total amount of fees paid to insurance company | USD $34 | | Are there contracts with allocated funds for individual policies? | 0 | | 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 | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $339,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99139061001 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 4 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99139061001 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 4 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99139061001 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99139061001 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 4 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99139061001 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 99139061001 |
| Policy instance | 4 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9913906 |
| Policy instance | 4 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 9913906 |
| Policy instance | 4 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 2 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0206540 |
| Policy instance | 1 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 042-2881-00 |
| Policy instance | 5 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 07091 |
| Policy instance | 4 |
