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BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 401k Plan overview

Plan NameBARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS
Plan identification number 501

BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Death benefits (include travel accident but not life insurance)
  • 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

BARBARA LYNCH GRUPPO, INC. has sponsored the creation of one or more 401k plans.

Company Name:BARBARA LYNCH GRUPPO, INC.
Employer identification number (EIN):261436812
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01BARBARA LYNCH2024-01-25
5012020-07-01ELIZABETH MAUL2022-02-02
5012019-07-01ELIZABETH MAUL2020-11-10
5012018-07-01ELIZABETH MAUL2019-12-16
5012017-07-01
5012016-07-01
5012015-07-01ELIZABETH MAUL
5012014-07-01ELIZABETH MAUL ELIZABETH MAUL2015-12-29
5012013-07-01ELIZABETH MAUL ELIZABETH MAUL2015-12-29
5012012-07-01ELIZABETH MAUL ELIZABETH MAUL2015-12-29
5012011-07-01ELIZABETH MAUL ELIZABETH MAUL2015-12-29

Plan Statistics for BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS

401k plan membership statisitcs for BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS

Measure Date Value
2022: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2022 401k membership
Total participants, beginning-of-year2022-07-01145
Total number of active participants reported on line 7a of the Form 55002022-07-01103
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01103
Number of employers contributing to the scheme2022-07-010
2020: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2020 401k membership
Total participants, beginning-of-year2020-07-01178
Total number of active participants reported on line 7a of the Form 55002020-07-0184
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-0184
Number of employers contributing to the scheme2020-07-010
2019: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2019 401k membership
Total participants, beginning-of-year2019-07-01176
Total number of active participants reported on line 7a of the Form 55002019-07-01178
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01178
Number of employers contributing to the scheme2019-07-010
2018: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2018 401k membership
Total participants, beginning-of-year2018-07-01191
Total number of active participants reported on line 7a of the Form 55002018-07-01176
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01176
Number of employers contributing to the scheme2018-07-010
2017: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2017 401k membership
Total participants, beginning-of-year2017-07-01185
Total number of active participants reported on line 7a of the Form 55002017-07-01191
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01191
2016: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2016 401k membership
Total participants, beginning-of-year2016-07-01109
Total number of active participants reported on line 7a of the Form 55002016-07-0192
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-0192
2015: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2015 401k membership
Total participants, beginning-of-year2015-07-01105
Total number of active participants reported on line 7a of the Form 55002015-07-01109
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01109
2014: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2014 401k membership
Total participants, beginning-of-year2014-07-01104
Total number of active participants reported on line 7a of the Form 55002014-07-01105
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01105
2013: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2013 401k membership
Total participants, beginning-of-year2013-07-01101
Total number of active participants reported on line 7a of the Form 55002013-07-01104
Total of all active and inactive participants2013-07-01104
2012: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2012 401k membership
Total participants, beginning-of-year2012-07-01107
Total number of active participants reported on line 7a of the Form 55002012-07-01101
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01101
2011: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2011 401k membership
Total participants, beginning-of-year2011-07-01110
Total number of active participants reported on line 7a of the Form 55002011-07-01107
Total of all active and inactive participants2011-07-01107

Form 5500 Responses for BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS

2022: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2020: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: BARBARA LYNCH GRUPPO, INC. HEALTH AND WELFARE PLANS 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01First time form 5500 has been submittedYes
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 3
Insurance contract or identification number65103000
Number of Individuals Covered43
Insurance policy start date2021-12-15
Insurance policy end date2022-12-14
Total amount of commissions paid to insurance brokerUSD $11,433
Total amount of fees paid to insurance companyUSD $3,310
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $217,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,433
Amount paid for insurance broker fees3310
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number411445
Policy instance 2
Insurance contract or identification number411445
Number of Individuals Covered103
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $239
Total amount of fees paid to insurance companyUSD $45
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $239
Amount paid for insurance broker fees45
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number513078
Policy instance 1
Insurance contract or identification number513078
Number of Individuals Covered39
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $2,690
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $27,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,983
Amount paid for insurance broker fees0
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 3
Insurance contract or identification number65103000
Number of Individuals Covered67
Insurance policy start date2019-12-15
Insurance policy end date2020-12-14
Total amount of commissions paid to insurance brokerUSD $19,531
Total amount of fees paid to insurance companyUSD $6,184
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $439,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,531
Amount paid for insurance broker fees6184
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number411445
Policy instance 2
Insurance contract or identification number411445
Number of Individuals Covered84
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $219
Total amount of fees paid to insurance companyUSD $44
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $219
Amount paid for insurance broker fees44
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number513078
Policy instance 1
Insurance contract or identification number513078
Number of Individuals Covered45
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $3,699
Total amount of fees paid to insurance companyUSD $3,748
Dental Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $42,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,237
Amount paid for insurance broker fees3748
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number411445
Policy instance 2
Insurance contract or identification number411445
Number of Individuals Covered178
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $300
Total amount of fees paid to insurance companyUSD $60
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $300
Amount paid for insurance broker fees60
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 3
Insurance contract or identification number65103000
Number of Individuals Covered98
Insurance policy start date2018-12-15
Insurance policy end date2019-12-14
Total amount of commissions paid to insurance brokerUSD $19,163
Total amount of fees paid to insurance companyUSD $4,206
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $485,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,163
Amount paid for insurance broker fees4206
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number513078
Policy instance 1
Insurance contract or identification number513078
Number of Individuals Covered91
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $4,412
Total amount of fees paid to insurance companyUSD $2,161
Dental Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $59,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,804
Amount paid for insurance broker fees2161
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number513078
Policy instance 1
Insurance contract or identification number513078
Number of Individuals Covered77
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $3,304
Total amount of fees paid to insurance companyUSD $2,276
Dental Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $46,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,584
Amount paid for insurance broker fees2276
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number411445
Policy instance 2
Insurance contract or identification number411445
Number of Individuals Covered176
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $339
Total amount of fees paid to insurance companyUSD $68
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $339
Amount paid for insurance broker fees68
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 3
Insurance contract or identification number65103000
Number of Individuals Covered89
Insurance policy start date2017-12-15
Insurance policy end date2018-12-14
Total amount of commissions paid to insurance brokerUSD $17,390
Total amount of fees paid to insurance companyUSD $5,944
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $423,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,390
Amount paid for insurance broker fees5944
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 3
Insurance contract or identification number65103000
Number of Individuals Covered113
Insurance policy start date2016-12-15
Insurance policy end date2017-12-14
Total amount of commissions paid to insurance brokerUSD $19,303
Total amount of fees paid to insurance companyUSD $4,785
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $524,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,303
Amount paid for insurance broker fees4785
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEASTERN BENEFITS GROUP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number411445
Policy instance 2
Insurance contract or identification number411445
Number of Individuals Covered191
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $384
Total amount of fees paid to insurance companyUSD $77
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $384
Amount paid for insurance broker fees77
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameEASTERN BENEFITS GROUP
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00513078
Policy instance 1
Insurance contract or identification number00513078
Number of Individuals Covered67
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,806
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,751
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameBULFINCH GROUP INSURANCE AGENCY
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 2
Insurance contract or identification number65103000
Number of Individuals Covered109
Insurance policy start date2014-12-15
Insurance policy end date2015-12-14
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $562,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,597
Insurance broker organization code?3
Insurance broker nameGLENN A. LEVINE
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number513078
Policy instance 1
Insurance contract or identification number513078
Number of Individuals Covered68
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $2,889
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $47,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,687
Insurance broker organization code?3
Insurance broker nameBULFINCH GROUP INSURANCE AGENCY
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number011555
Policy instance 1
Insurance contract or identification number011555
Number of Individuals Covered83
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $1,538
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,538
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGLENN A. LEVINE
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 2
Insurance contract or identification number65103000
Number of Individuals Covered128
Insurance policy start date2013-12-15
Insurance policy end date2014-12-14
Total amount of commissions paid to insurance brokerUSD $17,118
Total amount of fees paid to insurance companyUSD $785
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $451,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,118
Amount paid for insurance broker fees785
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker namePRUDENTIAL LIFE INSURNACE
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number011555
Policy instance 1
Insurance contract or identification number011555
Number of Individuals Covered87
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,783
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,783
Insurance broker organization code?3
Insurance broker nameGLENN A. LEVINE
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 2
Insurance contract or identification number65103000
Number of Individuals Covered123
Insurance policy start date2012-12-15
Insurance policy end date2013-12-14
Total amount of commissions paid to insurance brokerUSD $21,140
Total amount of fees paid to insurance companyUSD $999
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $501,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,140
Amount paid for insurance broker fees999
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker namePRUDENTIAL LIFE INSURNACE
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 1
Insurance contract or identification number65103000
Number of Individuals Covered124
Insurance policy start date2011-12-15
Insurance policy end date2012-12-14
Total amount of commissions paid to insurance brokerUSD $19,495
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $572,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,495
Insurance broker organization code?3
Insurance broker namePRUDENTIAL LIFE INSURNACE
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number011555
Policy instance 2
Insurance contract or identification number011555
Number of Individuals Covered83
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,911
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,911
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGLEEN A. LEVINE
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number65103000
Policy instance 1
Insurance contract or identification number65103000
Number of Individuals Covered119
Insurance policy start date2010-12-15
Insurance policy end date2011-12-14
Total amount of commissions paid to insurance brokerUSD $17,689
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $482,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number011555
Policy instance 2
Insurance contract or identification number011555
Number of Individuals Covered89
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,782
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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