401k Plan data: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN plan

FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 401k Plan overview

Plan Name	FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN
Plan identification number	502

FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover Collectively bargained welfare benefit arrangement under Code section 419A(f)(5).

401k Sponsoring company profile

FAIRPOINT COMMUNICATIONS, INC. has sponsored the creation of one or more 401k plans.

Company Name: FAIRPOINT COMMUNICATIONS, INC.

Employer identification number (EIN): 133725229

NAIC Classification: 517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2018-01-01 VIVIAN SCHOTT 2019-07-26
502 2017-01-01
502 2016-01-01 KAREN TURNER KAREN TURNER 2017-06-29
502 2015-01-01 KAREN TURNER KAREN TURNER 2016-06-22
502 2014-01-01 JOHN WHITENER JOHN WHITENER 2015-07-10
502 2013-01-01 KAREN TURNER KAREN TURNER 2014-07-01
502 2012-01-01 JOHN WHITENER JOHN WHITENER 2013-06-21
502 2011-01-01 JOHN WHITENER JOHN WHITENER 2012-07-24
502 2009-01-01 GARY GARVEY GARY GARVEY 2010-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2018-01-01	VIVIAN SCHOTT	2019-07-26
502	2017-01-01
502	2016-01-01	KAREN TURNER		KAREN TURNER	2017-06-29
502	2015-01-01	KAREN TURNER		KAREN TURNER	2016-06-22
502	2014-01-01	JOHN WHITENER		JOHN WHITENER	2015-07-10
502	2013-01-01	KAREN TURNER		KAREN TURNER	2014-07-01
502	2012-01-01	JOHN WHITENER		JOHN WHITENER	2013-06-21
502	2011-01-01	JOHN WHITENER		JOHN WHITENER	2012-07-24
502	2009-01-01	GARY GARVEY		GARY GARVEY	2010-07-27

Plan Statistics for FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN

401k plan membership statisitcs for FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN

Measure Date Value
2018: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2,775
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
Number of employers contributing to the scheme 2018-01-01 0
2017: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3,121
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2,296
Number of retired or separated participants receiving benefits 2017-01-01 432
Number of other retired or separated participants entitled to future benefits 2017-01-01 47
Total of all active and inactive participants 2017-01-01 2,775
2016: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 3,195
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2,629
Number of retired or separated participants receiving benefits 2016-01-01 443
Number of other retired or separated participants entitled to future benefits 2016-01-01 49
Total of all active and inactive participants 2016-01-01 3,121
2015: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,419
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2,717
Number of retired or separated participants receiving benefits 2015-01-01 462
Number of other retired or separated participants entitled to future benefits 2015-01-01 16
Total of all active and inactive participants 2015-01-01 3,195
2014: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,458
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,353
Number of retired or separated participants receiving benefits 2014-01-01 59
Number of other retired or separated participants entitled to future benefits 2014-01-01 7
Total of all active and inactive participants 2014-01-01 1,419
2013: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,505
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,394
Number of retired or separated participants receiving benefits 2013-01-01 64
Total of all active and inactive participants 2013-01-01 1,458
2012: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,595
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,462
Number of retired or separated participants receiving benefits 2012-01-01 43
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1,505
2011: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,753
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,564
Number of retired or separated participants receiving benefits 2011-01-01 31
Total of all active and inactive participants 2011-01-01 1,595
2009: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,134
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 769
Number of retired or separated participants receiving benefits 2009-01-01 28
Total of all active and inactive participants 2009-01-01 797
Total participants 2009-01-01 0

Measure	Date	Value
2018: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,775
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Number of employers contributing to the scheme	2018-01-01	0
2017: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3,121
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2,296
Number of retired or separated participants receiving benefits	2017-01-01	432
Number of other retired or separated participants entitled to future benefits	2017-01-01	47
Total of all active and inactive participants	2017-01-01	2,775
2016: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3,195
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,629
Number of retired or separated participants receiving benefits	2016-01-01	443
Number of other retired or separated participants entitled to future benefits	2016-01-01	49
Total of all active and inactive participants	2016-01-01	3,121
2015: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,419
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2,717
Number of retired or separated participants receiving benefits	2015-01-01	462
Number of other retired or separated participants entitled to future benefits	2015-01-01	16
Total of all active and inactive participants	2015-01-01	3,195
2014: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,458
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,353
Number of retired or separated participants receiving benefits	2014-01-01	59
Number of other retired or separated participants entitled to future benefits	2014-01-01	7
Total of all active and inactive participants	2014-01-01	1,419
2013: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,505
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,394
Number of retired or separated participants receiving benefits	2013-01-01	64
Total of all active and inactive participants	2013-01-01	1,458
2012: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,595
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,462
Number of retired or separated participants receiving benefits	2012-01-01	43
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1,505
2011: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,753
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,564
Number of retired or separated participants receiving benefits	2011-01-01	31
Total of all active and inactive participants	2011-01-01	1,595
2009: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,134
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	769
Number of retired or separated participants receiving benefits	2009-01-01	28
Total of all active and inactive participants	2009-01-01	797
Total participants	2009-01-01	0

Form 5500 Responses for FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN

2018: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	This submission is the final filing	Yes
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: FAIRPOINT COMMUNICATIONS COMPREHENSIVE GROUP BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	722
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $224,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	1994
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $49,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FPC

Policy instance

Insurance contract or identification number	FPC
Number of Individuals Covered	3000
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

135974P

Policy instance

Insurance contract or identification number	135974P
Number of Individuals Covered	2436
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,717
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,535,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	3717
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION SUPPLEMENTAL COMPENSATION, NON-MONETARY COMPENSATION
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	817
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FPC-FN1

Policy instance

Insurance contract or identification number	FPC-FN1
Number of Individuals Covered	2428
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $123,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

135974P

Policy instance

Insurance contract or identification number	135974P
Number of Individuals Covered	2726
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,538,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	2296
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $75,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

NONE

Policy instance

Insurance contract or identification number	NONE
Number of Individuals Covered	2717
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $88,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143645&014369

Policy instance

Insurance contract or identification number	0143645&014369
Number of Individuals Covered	1850
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEP. LIFE - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $223,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143932, 143624,

Policy instance

Insurance contract or identification number	143932, 143624,
Number of Individuals Covered	2676
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LTD
Welfare Benefit Premiums Paid to Carrier	USD $771,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	918
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $235,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143934

Policy instance

Insurance contract or identification number	0143934
Number of Individuals Covered	88
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NEW YORK DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $8,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143642, 29, 37

Policy instance

Insurance contract or identification number	0143642, 29, 37
Number of Individuals Covered	3159
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $916,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FRC-GROUP

Policy instance

Insurance contract or identification number	FRC-GROUP
Number of Individuals Covered	1423
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0140729

Policy instance

Insurance contract or identification number	0140729
Number of Individuals Covered	1046
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $7,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143918,143652,

Policy instance

Insurance contract or identification number	143918,143652,
Number of Individuals Covered	1479
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL LIFE & ADD
Welfare Benefit Premiums Paid to Carrier	USD $673,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974 J,K

Policy instance

Insurance contract or identification number	0135974 J,K
Number of Individuals Covered	1320
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LTD
Welfare Benefit Premiums Paid to Carrier	USD $256,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FRC-MANAGEMENT

Policy instance

Insurance contract or identification number	FRC-MANAGEMENT
Number of Individuals Covered	616
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974,A,B,E,F

Policy instance

Insurance contract or identification number	0135974,A,B,E,F
Number of Individuals Covered	1419
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $334,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

01365974,B,D,G,

Policy instance

Insurance contract or identification number	01365974,B,D,G,
Number of Individuals Covered	1373
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL LIFE & ADD
Welfare Benefit Premiums Paid to Carrier	USD $294,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974M

Policy instance

Insurance contract or identification number	0135974M
Number of Individuals Covered	98
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NEW YORK DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $9,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	626
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $172,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974,A,B,C

Policy instance

Insurance contract or identification number	0135974,A,B,C
Number of Individuals Covered	732
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEP. LIFE - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $76,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0140729

Policy instance

Insurance contract or identification number	0140729
Number of Individuals Covered	1142
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

NONE

Policy instance

Insurance contract or identification number	NONE
Number of Individuals Covered	1353
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $46,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0140729

Policy instance

Insurance contract or identification number	0140729
Number of Individuals Covered	1168
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FRC-MANAGEMENT

Policy instance

Insurance contract or identification number	FRC-MANAGEMENT
Number of Individuals Covered	498
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

01365974,B,D,G,

Policy instance

Insurance contract or identification number	01365974,B,D,G,
Number of Individuals Covered	746
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL LIFE & ADD
Welfare Benefit Premiums Paid to Carrier	USD $247,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974M

Policy instance

Insurance contract or identification number	0135974M
Number of Individuals Covered	105
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NEW YORK DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $9,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974,A,B,E,F

Policy instance

Insurance contract or identification number	0135974,A,B,E,F
Number of Individuals Covered	1469
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $337,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	650
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

NONE

Policy instance

Insurance contract or identification number	NONE
Number of Individuals Covered	1402
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $49,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974,A,B,C

Policy instance

Insurance contract or identification number	0135974,A,B,C
Number of Individuals Covered	1290
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEP. LIFE - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $86,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0135974 J,K

Policy instance

Insurance contract or identification number	0135974 J,K
Number of Individuals Covered	1701
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LTD
Welfare Benefit Premiums Paid to Carrier	USD $247,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

140729

Policy instance

Insurance contract or identification number	140729
Number of Individuals Covered	1223
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143649,143645

Policy instance

Insurance contract or identification number	0143649,143645
Number of Individuals Covered	676
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEP. LIFE - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $60,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143624, 014626

Policy instance

Insurance contract or identification number	0143624, 014626
Number of Individuals Covered	1859
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LTD
Welfare Benefit Premiums Paid to Carrier	USD $313,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FRC-MANAGEMENT

Policy instance

Insurance contract or identification number	FRC-MANAGEMENT
Number of Individuals Covered	545
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143652,18,35,3

Policy instance

Insurance contract or identification number	0143652,18,35,3
Number of Individuals Covered	665
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL LIFE & ADD
Welfare Benefit Premiums Paid to Carrier	USD $241,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143629,42,37

Policy instance

Insurance contract or identification number	0143629,42,37
Number of Individuals Covered	1539
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $350,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143934

Policy instance

Insurance contract or identification number	0143934
Number of Individuals Covered	112
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NEW YORK DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $10,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	693
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $156,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

Policy instance

Number of Individuals Covered	1482
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $51,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143629,42,37,3

Policy instance

Insurance contract or identification number	0143629,42,37,3
Number of Individuals Covered	1709
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $491,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143652,18,35

Policy instance

Insurance contract or identification number	0143652,18,35
Number of Individuals Covered	690
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL LIFE & ADD
Welfare Benefit Premiums Paid to Carrier	USD $291,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

009941;009943;

Policy instance

Insurance contract or identification number	009941;009943;
Number of Individuals Covered	418
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,028,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FRC-MANAGEMENT

Policy instance

Insurance contract or identification number	FRC-MANAGEMENT
Number of Individuals Covered	1315
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,278
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143624 & 26

Policy instance

Insurance contract or identification number	0143624 & 26
Number of Individuals Covered	1519
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LTD
Welfare Benefit Premiums Paid to Carrier	USD $401,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

140729

Policy instance

Insurance contract or identification number	140729
Number of Individuals Covered	1321
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $8,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-007444-00

Policy instance

Insurance contract or identification number	16-007444-00
Number of Individuals Covered	1564
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $12,023
Welfare Benefit Premiums Paid to Carrier	USD $512,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143645

Policy instance

Insurance contract or identification number	143645
Number of Individuals Covered	322
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	732
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $173,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143934

Policy instance

Insurance contract or identification number	0143934
Number of Individuals Covered	119
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NEW YORK DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $11,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143649

Policy instance

Insurance contract or identification number	0143649
Number of Individuals Covered	437
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	DEP. LIFE - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $48,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

Policy instance

Number of Individuals Covered	1597
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $58,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-007444-00

Policy instance

Insurance contract or identification number	16-007444-00
Number of Individuals Covered	1698
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $455,583

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

Policy instance

Number of Individuals Covered	1698
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $59,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12320991

Policy instance

Insurance contract or identification number	12320991
Number of Individuals Covered	784
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143934

Policy instance

Insurance contract or identification number	0143934
Number of Individuals Covered	130
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NEW YORK DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $11,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

143645

Policy instance

Insurance contract or identification number	143645
Number of Individuals Covered	279
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

014329,42,37

Policy instance

Insurance contract or identification number	014329,42,37
Number of Individuals Covered	1698
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
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 $484,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0143652,18,35

Policy instance

Insurance contract or identification number	0143652,18,35
Number of Individuals Covered	1310
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL LIFE & ADD
Welfare Benefit Premiums Paid to Carrier	USD $288,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

FRC-MANAGEMENT

Policy instance

Insurance contract or identification number	FRC-MANAGEMENT
Number of Individuals Covered	116
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $520
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	520
Additional information about fees paid to insurance broker	INSURANCE FEES
Insurance broker organization code?	3
Insurance broker name	HIGHMARK LIFE INSURANCE COMPANY

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

Policy contract number

0143624 & 26

Policy instance

Insurance contract or identification number	0143624 & 26
Number of Individuals Covered	1640
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LTD
Welfare Benefit Premiums Paid to Carrier	USD $388,307

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

Policy contract number

140729

Policy instance

Insurance contract or identification number	140729
Number of Individuals Covered	1749
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $8,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

009941;009943;

Policy instance

Insurance contract or identification number	009941;009943;
Number of Individuals Covered	1070
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,976,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FAIRPOINT COMMUNICATIONS, INC.
Employer identification number (EIN):	133725229
NAIC Classification:	517000