401k Plan data: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN plan

COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 401k Plan overview

Plan Name	COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN
Plan identification number	503

COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN Benefits

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

401k Sponsoring company profile

COORDINATES OPERATIONS LLC has sponsored the creation of one or more 401k plans.

Company Name: COORDINATES OPERATIONS LLC

Employer identification number (EIN): 272192607

NAIC Classification: 541512
NAIC Description: Computer Systems Design Services

Additional information about COORDINATES OPERATIONS LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4803673

More information about COORDINATES OPERATIONS LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01 CLIFFORD A. LASSER 2024-02-12
503 2021-01-01 CLIFFORD A. LASSER 2022-10-17
503 2020-01-01 CLIFFORD A. LASSER 2021-10-13
503 2019-01-01 CLIFFORD A. LASSER 2020-10-13
503 2018-01-01 CLIFFORD A. LASSER 2019-10-15
503 2017-01-01
503 2016-01-01
503 2015-01-01
503 2014-01-01
503 2013-01-01
503 2012-01-01 JAMES L BURKE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2022-01-01	CLIFFORD A. LASSER	2024-02-12
503	2021-01-01	CLIFFORD A. LASSER	2022-10-17
503	2020-01-01	CLIFFORD A. LASSER	2021-10-13
503	2019-01-01	CLIFFORD A. LASSER	2020-10-13
503	2018-01-01	CLIFFORD A. LASSER	2019-10-15
503	2017-01-01
503	2016-01-01
503	2015-01-01
503	2014-01-01
503	2013-01-01
503	2012-01-01	JAMES L BURKE

Plan Statistics for COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN

401k plan membership statisitcs for COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN

Measure Date Value
2022: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 540
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 584
Total of all active and inactive participants 2022-01-01 584
2021: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 489
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 540
Total of all active and inactive participants 2021-01-01 540
2020: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 460
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 489
Total of all active and inactive participants 2020-01-01 489
2019: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 421
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 460
Total of all active and inactive participants 2019-01-01 460
2018: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 392
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 421
Total of all active and inactive participants 2018-01-01 421
2017: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 361
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 392
Total of all active and inactive participants 2017-01-01 392
2016: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 346
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 361
Total of all active and inactive participants 2016-01-01 361
2015: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 330
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 346
Total of all active and inactive participants 2015-01-01 346
2014: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 307
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 330
Total of all active and inactive participants 2014-01-01 330
2013: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 298
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 307
Total of all active and inactive participants 2013-01-01 307
2012: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 280
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 298
Total of all active and inactive participants 2012-01-01 298

Measure	Date	Value
2022: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	540
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	584
Total of all active and inactive participants	2022-01-01	584
2021: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	489
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	540
Total of all active and inactive participants	2021-01-01	540
2020: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	460
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	489
Total of all active and inactive participants	2020-01-01	489
2019: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	421
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	460
Total of all active and inactive participants	2019-01-01	460
2018: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	392
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	421
Total of all active and inactive participants	2018-01-01	421
2017: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	361
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	392
Total of all active and inactive participants	2017-01-01	392
2016: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	346
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	361
Total of all active and inactive participants	2016-01-01	361
2015: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	330
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	346
Total of all active and inactive participants	2015-01-01	346
2014: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	307
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	330
Total of all active and inactive participants	2014-01-01	330
2013: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	298
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	307
Total of all active and inactive participants	2013-01-01	307
2012: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	280
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	298
Total of all active and inactive participants	2012-01-01	298

Form 5500 Responses for COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN

2022: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2021-09-28
Insurance policy end date	2022-09-28
Total amount of commissions paid to insurance broker	USD $1,972
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,972
Insurance broker organization code?	3

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

Policy contract number

07194A

Policy instance

Insurance contract or identification number	07194A
Number of Individuals Covered	4
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,123
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $131,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,123
Insurance broker organization code?	3

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 252105

Policy instance

Insurance contract or identification number	DBL 252105
Number of Individuals Covered	52
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,646
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	DIS BENEFIT LAW-NY PD FAM LEAVE/STD
Welfare Benefit Premiums Paid to Carrier	USD $12,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,646
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 127545

Policy instance

Insurance contract or identification number	LTD 127545
Number of Individuals Covered	409
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,091
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $338,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,091
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 155941

Policy instance

Insurance contract or identification number	GL 155941
Number of Individuals Covered	570
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,276
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $299,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,276
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 168456

Policy instance

Insurance contract or identification number	G 168456
Number of Individuals Covered	946
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,067
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	WEEKLY INCOME-MA MEDICAL AND FAMILY
Welfare Benefit Premiums Paid to Carrier	USD $288,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,067
Insurance broker organization code?	3

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	1933
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $239,705
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $239,705
Insurance broker organization code?	3

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	1806
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $198,564
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $198,564
Insurance broker organization code?	3

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2020-09-28
Insurance policy end date	2021-09-28
Total amount of commissions paid to insurance broker	USD $1,967
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,967
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 155941

Policy instance

Insurance contract or identification number	GL 155941
Number of Individuals Covered	530
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,658
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $298,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,658
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 127545

Policy instance

Insurance contract or identification number	LTD 127545
Number of Individuals Covered	390
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $13,431
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $342,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,431
Insurance broker organization code?	3

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 252105

Policy instance

Insurance contract or identification number	DBL 252105
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,142
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	DISABILITY BENEFIT LAW
Welfare Benefit Premiums Paid to Carrier	USD $9,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,142
Insurance broker organization code?	3

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

Policy contract number

07194A

Policy instance

Insurance contract or identification number	07194A
Number of Individuals Covered	3
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $13,804
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $138,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,804
Insurance broker organization code?	3

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

MAL 168456

Policy instance

Insurance contract or identification number	MAL 168456
Number of Individuals Covered	456
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,000
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $250,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,000
Insurance broker organization code?	3

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	1789
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $184,105
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $184,105
Insurance broker organization code?	3

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2019-09-28
Insurance policy end date	2020-09-28
Total amount of commissions paid to insurance broker	USD $1,850
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,850

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 155941

Policy instance

Insurance contract or identification number	GL 155941
Number of Individuals Covered	500
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,256
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $227,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,256
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 127545

Policy instance

Insurance contract or identification number	LTD 127545
Number of Individuals Covered	380
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,797
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $266,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,797
Insurance broker organization code?	3

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 252105

Policy instance

Insurance contract or identification number	DBL 252105
Number of Individuals Covered	34
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $505
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	DISABILITY BENEFIT LAW
Welfare Benefit Premiums Paid to Carrier	USD $4,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $505
Insurance broker organization code?	3

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

Policy contract number

07194A

Policy instance

Insurance contract or identification number	07194A
Number of Individuals Covered	3
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $12,948
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $129,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,948

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 155941

Policy instance

Insurance contract or identification number	GL 155941
Number of Individuals Covered	458
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,130
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $225,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,130
Insurance broker organization code?	3

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

Policy contract number

07194A

Policy instance

Insurance contract or identification number	07194A
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,812
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $118,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,812

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 252105

Policy instance

Insurance contract or identification number	DBL 252105
Number of Individuals Covered	34
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $343
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	DISABILITY BENEFIT LAW
Welfare Benefit Premiums Paid to Carrier	USD $2,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $343
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 164890

Policy instance

Insurance contract or identification number	G 164890
Number of Individuals Covered	351
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,420
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,420
Insurance broker organization code?	3

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	1697
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $176,141
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $176,141
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 127545

Policy instance

Insurance contract or identification number	LTD 127545
Number of Individuals Covered	359
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,219
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $316,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,219
Insurance broker organization code?	3

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2018-09-28
Insurance policy end date	2019-09-28
Total amount of commissions paid to insurance broker	USD $1,952
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,952

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2017-08-29
Insurance policy end date	2018-08-28
Total amount of commissions paid to insurance broker	USD $1,952
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,952

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

Policy contract number

07194A

Policy instance

Insurance contract or identification number	07194A
Number of Individuals Covered	3
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,744
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION
Welfare Benefit Premiums Paid to Carrier	USD $83,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,744

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 252105

Policy instance

Insurance contract or identification number	DBL 252105
Number of Individuals Covered	30
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $256
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	DISABILITY BENEFIT LAW
Welfare Benefit Premiums Paid to Carrier	USD $2,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $256
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 164890

Policy instance

Insurance contract or identification number	G 164890
Number of Individuals Covered	332
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,887
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,887
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 127545

Policy instance

Insurance contract or identification number	LTD 127545
Number of Individuals Covered	340
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,592
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $313,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,592
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 155941

Policy instance

Insurance contract or identification number	GL 155941
Number of Individuals Covered	421
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,414
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $220,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,414
Insurance broker organization code?	3

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	1620
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $169,357
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $169,357
Insurance broker organization code?	3

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	1553
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $146,989
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $146,989
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT INS SERVICES INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 155941

Policy instance

Insurance contract or identification number	GL 155941
Number of Individuals Covered	406
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,011
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $188,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,011
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 127545

Policy instance

Insurance contract or identification number	LTD 127545
Number of Individuals Covered	325
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,984
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $242,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,984
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

G 164890

Policy instance

Insurance contract or identification number	G 164890
Number of Individuals Covered	314
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,944
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,944
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2016-08-29
Insurance policy end date	2017-08-28
Total amount of commissions paid to insurance broker	USD $1,768
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,768
Insurance broker organization code?	3
Insurance broker name	DELAND GIBSON INSURANCE ASSOC

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

DBL 252105

Policy instance

Insurance contract or identification number	DBL 252105
Number of Individuals Covered	15
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $93
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	DISABILITY BENEFIT LAW
Welfare Benefit Premiums Paid to Carrier	USD $761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2014-08-29
Insurance policy end date	2015-08-28
Total amount of commissions paid to insurance broker	USD $1,918
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ADD/
Welfare Benefit Premiums Paid to Carrier	USD $11,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,918
Insurance broker organization code?	3
Insurance broker name	DELAND GIBSON INSURANCE ASSOC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05987383

Policy instance

Insurance contract or identification number	TM05987383
Number of Individuals Covered	367
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,565
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD/
Welfare Benefit Premiums Paid to Carrier	USD $420,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,565
Insurance broker organization code?	3
Insurance broker name	WILLIAM GALLAGHER ASSOCIATES

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	1011
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $124,241
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $124,241
Insurance broker organization code?	3
Insurance broker name	WILLIAM GALLAGHER ASSOCIATES

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	991
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $110,997
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $110,997
Insurance broker organization code?	3
Insurance broker name	WILLIAM GALLAGHER ASSOCIATES

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2013-08-29
Insurance policy end date	2014-08-28
Total amount of commissions paid to insurance broker	USD $1,918
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ADD/
Welfare Benefit Premiums Paid to Carrier	USD $11,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,918
Insurance broker organization code?	3
Insurance broker name	DELAND GIBSON INSURANCE ASSOC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05987383

Policy instance

Insurance contract or identification number	TM05987383
Number of Individuals Covered	351
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,095
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD/
Welfare Benefit Premiums Paid to Carrier	USD $394,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,095
Insurance broker organization code?	3
Insurance broker name	WILLIAM GALLAGHER ASSOCIATES

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099067547

Policy instance

Insurance contract or identification number	000099067547
Number of Individuals Covered	20
Insurance policy start date	2012-08-29
Insurance policy end date	2013-08-28
Total amount of commissions paid to insurance broker	USD $1,918
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ADD/
Welfare Benefit Premiums Paid to Carrier	USD $11,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,918
Insurance broker organization code?	3
Insurance broker name	DELAND GIBSON INSURANCE ASSOC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05987383

Policy instance

Insurance contract or identification number	TM05987383
Number of Individuals Covered	336
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,031
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD/
Welfare Benefit Premiums Paid to Carrier	USD $344,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,031
Insurance broker organization code?	3
Insurance broker name

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	935
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $107,843
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,843
Insurance broker organization code?	3
Insurance broker name	WILLIAM GALLAGHER ASSOCIATES

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

Policy contract number

4830821

Policy instance

Insurance contract or identification number	4830821
Number of Individuals Covered	881
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $99,447
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $99,447
Insurance broker organization code?	3
Insurance broker name	WILLIAM GALLAGHER ASSOCIATES

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05987383

Policy instance

Insurance contract or identification number	TM05987383
Number of Individuals Covered	320
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,472
Total amount of fees paid to insurance company	USD $28
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD/
Welfare Benefit Premiums Paid to Carrier	USD $346,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,972
Insurance broker organization code?	3
Amount paid for insurance broker fees	28
Additional information about fees paid to insurance broker	NON MONETARY COMP
Insurance broker name	WILLIAM GALLAGHER ASSOCIATES

Potentially related plans

COORDINATES OPERATIONS LLC BENEFITS WRAP PLAN [EIN = 043258202]

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Company Name:	COORDINATES OPERATIONS LLC
Employer identification number (EIN):	272192607
NAIC Classification:	541512
NAIC Description:	Computer Systems Design Services

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4803673