Fidelity bond in place
Not reported
Filing
Blue Cod Technologies Inc. Welfare Plan
Blue Cod Technologies Inc. • EIN 04-3550825 • Plan year 2008
Filing Insights
Participants
Up99 → 157
58 • 58.59%
Assets
No comparison- → -
No earlier value available.
Investment Management Fee
-
Admin expenses - • Total expenses -
Filing Details
ContextNo event flags were generated for this filing.
Status Flags
Limited-scope audit performed
Not reported
Contributions transmitted on time
Not reported
Participant loans in default
Not reported
Leases in default
Not reported
Reportable party-in-interest issues
Not reported
Loss discovered during year
Not reported
Assets with undetermined value
Not reported
Non-cash contributions
Not reported
Assets held for investment
Not reported
5% transactions reported
Not reported
All plan assets distributed
Not reported
Benefits paid when due
Not reported
Plan blackout period
Not reported
Plan termination resolution adopted
Not reported
Counterparties
Company Timeline
This filing is highlighted inside the broader sponsor history.
| Year / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2015 | 1 | 77 | $3,792,623 | $338,071 | $4,391iApproximate average salary by contribution assumption: employee only about $109,763 at 4% or $73,176 at 6%; with 50% employer match about $73,176 at 4% or $48,784 at 6%; with 100% employer match about $54,882 at 4% or $36,588 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401(K) PLAN | - | 77 | $3,792,623 | $338,071 | $4,391iApproximate average salary by contribution assumption: employee only about $109,763 at 4% or $73,176 at 6%; with 50% employer match about $73,176 at 4% or $48,784 at 6%; with 100% employer match about $54,882 at 4% or $36,588 at 6%. |
| 2014 | 1 | 64 | $3,926,243 | $281,821 | $4,403iApproximate average salary by contribution assumption: employee only about $110,086 at 4% or $73,391 at 6%; with 50% employer match about $73,391 at 4% or $48,927 at 6%; with 100% employer match about $55,043 at 4% or $36,695 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401(K) PLAN | - | 64 | $3,926,243 | $281,821 | $4,403iApproximate average salary by contribution assumption: employee only about $110,086 at 4% or $73,391 at 6%; with 50% employer match about $73,391 at 4% or $48,927 at 6%; with 100% employer match about $55,043 at 4% or $36,695 at 6%. |
| 2013 | 1 | 72 | $4,100,416 | $281,994 | $3,917iApproximate average salary by contribution assumption: employee only about $97,915 at 4% or $65,276 at 6%; with 50% employer match about $65,276 at 4% or $43,518 at 6%; with 100% employer match about $48,957 at 4% or $32,638 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401(K) PLAN | - | 72 | $4,100,416 | $281,994 | $3,917iApproximate average salary by contribution assumption: employee only about $97,915 at 4% or $65,276 at 6%; with 50% employer match about $65,276 at 4% or $43,518 at 6%; with 100% employer match about $48,957 at 4% or $32,638 at 6%. |
| 2012 | 2 | 77 | $3,979,282 | $325,000 | $4,221iApproximate average salary by contribution assumption: employee only about $105,519 at 4% or $70,346 at 6%; with 50% employer match about $70,346 at 4% or $46,898 at 6%; with 100% employer match about $52,760 at 4% or $35,173 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401(K) PLAN | - | 77 | $3,979,282 | $325,000 | $4,221iApproximate average salary by contribution assumption: employee only about $105,519 at 4% or $70,346 at 6%; with 50% employer match about $70,346 at 4% or $46,898 at 6%; with 100% employer match about $52,760 at 4% or $35,173 at 6%. |
| Blue Cod Technologies Inc. Welfare Plan | - | 71 | - | - | - |
| 2011 | 2 | 114 | $4,373,712 | $814,800 | $7,147iApproximate average salary by contribution assumption: employee only about $178,684 at 4% or $119,123 at 6%; with 50% employer match about $119,123 at 4% or $79,415 at 6%; with 100% employer match about $89,342 at 4% or $59,561 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401(K) PLAN | - | 114 | $4,373,712 | $814,800 | $7,147iApproximate average salary by contribution assumption: employee only about $178,684 at 4% or $119,123 at 6%; with 50% employer match about $119,123 at 4% or $79,415 at 6%; with 100% employer match about $89,342 at 4% or $59,561 at 6%. |
| Blue Cod Technologies Inc. Welfare Plan | - | 111 | - | - | - |
| 2010 | 2 | 214 | $4,415,168 | $1,370,507 | $6,404iApproximate average salary by contribution assumption: employee only about $160,106 at 4% or $106,737 at 6%; with 50% employer match about $106,737 at 4% or $71,158 at 6%; with 100% employer match about $80,053 at 4% or $53,369 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401(K) PLAN | - | 214 | $4,415,168 | $1,370,507 | $6,404iApproximate average salary by contribution assumption: employee only about $160,106 at 4% or $106,737 at 6%; with 50% employer match about $106,737 at 4% or $71,158 at 6%; with 100% employer match about $80,053 at 4% or $53,369 at 6%. |
| Blue Cod Technologies Inc. Welfare Plan | - | 200 | - | - | - |
| 2009 | 2 | 177 | $2,710,955 | $1,169,598 | $6,608iApproximate average salary by contribution assumption: employee only about $165,197 at 4% or $110,132 at 6%; with 50% employer match about $110,132 at 4% or $73,421 at 6%; with 100% employer match about $82,599 at 4% or $55,066 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401(K) PLAN | - | 177 | $2,710,955 | $1,169,598 | $6,608iApproximate average salary by contribution assumption: employee only about $165,197 at 4% or $110,132 at 6%; with 50% employer match about $110,132 at 4% or $73,421 at 6%; with 100% employer match about $82,599 at 4% or $55,066 at 6%. |
| Blue Cod Technologies Inc. Welfare Plan | - | 176 | - | - | - |
| 2008 | 2 | 157 | $1,087,427 | $721,453 | $4,595iApproximate average salary by contribution assumption: employee only about $114,881 at 4% or $76,587 at 6%; with 50% employer match about $76,587 at 4% or $51,058 at 6%; with 100% employer match about $57,441 at 4% or $38,294 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401K PLAN | - | 141 | $1,087,427 | $721,453 | $5,117iApproximate average salary by contribution assumption: employee only about $127,917 at 4% or $85,278 at 6%; with 50% employer match about $85,278 at 4% or $56,852 at 6%; with 100% employer match about $63,959 at 4% or $42,639 at 6%. |
| Blue Cod Technologies Inc. Welfare Plan | Current | 157 | - | - | - |
| 2007 | 1 | 53 | $802,106 | $343,630 | $6,484iApproximate average salary by contribution assumption: employee only about $162,090 at 4% or $108,060 at 6%; with 50% employer match about $108,060 at 4% or $72,040 at 6%; with 100% employer match about $81,045 at 4% or $54,030 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401K PLAN | - | 53 | $802,106 | $343,630 | $6,484iApproximate average salary by contribution assumption: employee only about $162,090 at 4% or $108,060 at 6%; with 50% employer match about $108,060 at 4% or $72,040 at 6%; with 100% employer match about $81,045 at 4% or $54,030 at 6%. |
| 2006 | 1 | 27 | $443,016 | $216,807 | $8,030iApproximate average salary by contribution assumption: employee only about $200,747 at 4% or $133,831 at 6%; with 50% employer match about $133,831 at 4% or $89,221 at 6%; with 100% employer match about $100,374 at 4% or $66,916 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401K PLAN | - | 27 | $443,016 | $216,807 | $8,030iApproximate average salary by contribution assumption: employee only about $200,747 at 4% or $133,831 at 6%; with 50% employer match about $133,831 at 4% or $89,221 at 6%; with 100% employer match about $100,374 at 4% or $66,916 at 6%. |
| 2005 | 1 | 30 | $185,520 | $179,263 | $5,975iApproximate average salary by contribution assumption: employee only about $149,386 at 4% or $99,591 at 6%; with 50% employer match about $99,591 at 4% or $66,394 at 6%; with 100% employer match about $74,693 at 4% or $49,795 at 6%. |
| BLUE COD TECHNOLOGIES, INC. 401K PLAN | - | 30 | $185,520 | $179,263 | $5,975iApproximate average salary by contribution assumption: employee only about $149,386 at 4% or $99,591 at 6%; with 50% employer match about $99,591 at 4% or $66,394 at 6%; with 100% employer match about $74,693 at 4% or $49,795 at 6%. |
Schedule Details
Schedule A
- Row 1
- Filing Id
- 84037264651549
- Form Id
- 98367553
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8030379264651040002
- Ins Broker 01 Name
- KEVIN KAEDING
- Ins Broker 01 Street Addr
- 420 LAKESIDE AVENUE
- Ins Broker 01 City
- MARLBOROUGH
- Ins Broker 01 State
- MA
- Ins Broker 01 ZIP Code
- 01752
- Ins Broker Comm Pd 01 Amount
- $8,477
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 2
- Filing Id
- 84037264651549
- Form Id
- 98367554
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8030379264651040003
- Ins Broker 01 Name
- KAEDING ERNST & CO
- Ins Broker 01 Street Addr
- 420 LAKESIDE AVENUE
- Ins Broker 01 City
- MARLBOROUGH
- Ins Broker 01 State
- MA
- Ins Broker 01 ZIP Code
- 01752
- Ins Broker Comm Pd 01 Amount
- $2,521
- Ins Broker Fees Pd 01 Amount
- $27
- Ins Broker Fees Pd 01 Text
- BONUS
- Ins Broker 01 Code
- 3
- Row 3
- Filing Id
- 84037264651549
- Form Id
- 98367557
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8030379264651040006
- Ins Broker 01 Name
- KAEDING ERNST & CO
- Ins Broker 01 Street Addr
- 420 LAKESIDE AVENUE
- Ins Broker 01 City
- MARLBOROUGH
- Ins Broker 01 State
- MA
- Ins Broker 01 ZIP Code
- 01752
- Ins Broker Comm Pd 01 Amount
- $625
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 4
- Filing Id
- 84037264651549
- Form Id
- 98367556
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8030379264651040005
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 5
- Filing Id
- 84037264651549
- Form Id
- 98367555
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8030379264651040004
- Ins Broker 01 Name
- KAEDING ERNST & CO
- Ins Broker 01 Street Addr
- 420 LAKESIDE AVENUE
- Ins Broker 01 City
- MARLBOROUGH
- Ins Broker 01 State
- MA
- Ins Broker 01 ZIP Code
- 01752
- Ins Broker Comm Pd 01 Amount
- $7,489
- Ins Broker Fees Pd 01 Amount
- $139
- Ins Broker Fees Pd 01 Text
- BONUS
- Ins Broker 01 Code
- 3
- Row 6
- Filing Id
- 84037264651549
- Form Id
- 98367558
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8030379264651040007
- Ins Broker 01 Name
- KAEDING ERNST & CO
- Ins Broker 01 Street Addr
- 420 LAKESIDE AVENUE
- Ins Broker 01 City
- MARLBOROUGH
- Ins Broker 01 State
- MA
- Ins Broker 01 ZIP Code
- 01752
- Ins Broker Comm Pd 01 Amount
- $6,017
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 7
- Ins Carrier Name: UNUM LIFE INSURANCE COMPANY OF AMERICA
- Filing Id
- 84037264651549
- Form Id
- 98367553
- Schedule A EIN
- 04-3550825
- Schedule A Plan Num
- 502
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- UNUM LIFE INSURANCE COMPANY OF AMERICA
- Ins Carrier EIN
- 01-0278678
- Ins Carrier Naic Code
- 62235
- Ins Contract Num
- 585411
- Ins Prsn Covered End of year Count
- 157
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $8,477
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- DEFM
- Wlfr Type Bnft Oth Text
- AD&D
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $86,736
- Wlfr Acquis Cost Amount
- $0
- Row 8
- Ins Carrier Name: DELTA DENTAL OF MASSACHUSETTS
- Filing Id
- 84037264651549
- Form Id
- 98367558
- Schedule A EIN
- 04-3550825
- Schedule A Plan Num
- 502
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- DELTA DENTAL OF MASSACHUSETTS
- Ins Carrier EIN
- 04-6143185
- Ins Carrier Naic Code
- 52060
- Ins Contract Num
- 004590
- Ins Prsn Covered End of year Count
- 119
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $6,017
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- B
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $152,625
- Wlfr Acquis Cost Amount
- $0
- Row 9
- Ins Carrier Name: BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC.
- Filing Id
- 84037264651549
- Form Id
- 98367556
- Schedule A EIN
- 04-3550825
- Schedule A Plan Num
- 502
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC.
- Ins Carrier EIN
- 04-1045815
- Ins Carrier Naic Code
- 53228
- Ins Contract Num
- 4947612
- Ins Prsn Covered End of year Count
- 14
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- A
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $38,754
- Wlfr Acquis Cost Amount
- $0
- Row 10
- Ins Carrier Name: BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC.
- Filing Id
- 84037264651549
- Form Id
- 98367554
- Schedule A EIN
- 04-3550825
- Schedule A Plan Num
- 502
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC.
- Ins Carrier EIN
- 04-1045815
- Ins Carrier Naic Code
- 53228
- Ins Contract Num
- 4942338
- Ins Prsn Covered End of year Count
- 295
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $2,521
- Ins Broker Fees Total Amount
- $27
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- B
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $43,322
- Wlfr Acquis Cost Amount
- $0
- Row 11
- Ins Carrier Name: BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC.
- Filing Id
- 84037264651549
- Form Id
- 98367555
- Schedule A EIN
- 04-3550825
- Schedule A Plan Num
- 502
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC.
- Ins Carrier EIN
- 04-1045815
- Ins Carrier Naic Code
- 53228
- Ins Contract Num
- 4942338
- Ins Prsn Covered End of year Count
- 64
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $7,489
- Ins Broker Fees Total Amount
- $139
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- A
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $226,936
- Wlfr Acquis Cost Amount
- $0
- Row 12
- Ins Carrier Name: EYEMED VISION CARE
- Filing Id
- 84037264651549
- Form Id
- 98367557
- Schedule A EIN
- 04-3550825
- Schedule A Plan Num
- 502
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- EYEMED VISION CARE
- Ins Carrier EIN
- 43-0949844
- Ins Carrier Naic Code
- 71870
- Ins Contract Num
- 9718917
- Ins Prsn Covered End of year Count
- 161
- Ins Policy From Date
- 2008-05-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $625
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- C
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $7,356
- Wlfr Acquis Cost Amount
- $0