401k Plan data: GEISINGER HEALTH SYSTEM WELFARE PLAN plan

GEISINGER HEALTH SYSTEM WELFARE PLAN 401k Plan overview

Plan Name	GEISINGER HEALTH SYSTEM WELFARE PLAN
Plan identification number	513

GEISINGER HEALTH SYSTEM WELFARE 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

401k Sponsoring company profile

GEISINGER SYSTEM SERVICES has sponsored the creation of one or more 401k plans.

Company Name: GEISINGER SYSTEM SERVICES

Employer identification number (EIN): 232164794

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about GEISINGER SYSTEM SERVICES

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2015-03-04

Company Identification Number: 0802168270

Legal Registered Office Address: 1999 BRYAN ST STE 900

DALLAS
United States of America (USA)
75201

More information about GEISINGER SYSTEM SERVICES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GEISINGER HEALTH SYSTEM WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
513 2023-01-01
513 2022-01-01
513 2021-01-01
513 2020-01-01
513 2019-01-01
513 2018-01-01 WENDY M. MARSHALL
513 2017-01-01 WENDY M. MARSHALL
513 2016-01-01 WENDY M. MARSHALL
513 2015-01-01 WENDY M. MARSHALL
513 2014-01-01 WENDY MARSHALL
513 2013-01-01 AMY BRAYFORD
513 2012-01-01 AMY BRAYFORD
513 2011-01-01 AMY BRAYFORD
513 2010-01-01 RICHARD MERKLE
513 2009-01-01 RICHARD MERKLE

Plan Statistics for GEISINGER HEALTH SYSTEM WELFARE PLAN

401k plan membership statisitcs for GEISINGER HEALTH SYSTEM WELFARE PLAN

Measure Date Value
2023: GEISINGER HEALTH SYSTEM WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 26,099
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 26,054
Number of retired or separated participants receiving benefits 2023-01-01 477
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 26,531
2022: GEISINGER HEALTH SYSTEM WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 24,361
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 25,515
Number of retired or separated participants receiving benefits 2022-01-01 423
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 25,938
2021: GEISINGER HEALTH SYSTEM WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 24,205
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 23,967
Number of retired or separated participants receiving benefits 2021-01-01 586
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 24,553
2020: GEISINGER HEALTH SYSTEM WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 27,064
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 23,524
Number of retired or separated participants receiving benefits 2020-01-01 687
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 24,211
2019: GEISINGER HEALTH SYSTEM WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 26,099
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 26,252
Number of retired or separated participants receiving benefits 2019-01-01 687
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 26,939
2018: GEISINGER HEALTH SYSTEM WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 25,858
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 25,500
Number of retired or separated participants receiving benefits 2018-01-01 589
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 26,089
2017: GEISINGER HEALTH SYSTEM WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 23,739
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 23,766
Number of retired or separated participants receiving benefits 2017-01-01 773
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 24,539
2016: GEISINGER HEALTH SYSTEM WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 22,289
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 22,287
Number of retired or separated participants receiving benefits 2016-01-01 708
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 22,995
2015: GEISINGER HEALTH SYSTEM WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 19,553
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 19,143
Number of retired or separated participants receiving benefits 2015-01-01 779
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 19,922
2014: GEISINGER HEALTH SYSTEM WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 16,825
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 15,865
Number of retired or separated participants receiving benefits 2014-01-01 582
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 16,447
2013: GEISINGER HEALTH SYSTEM WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 17,031
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 15,971
Number of retired or separated participants receiving benefits 2013-01-01 613
Total of all active and inactive participants 2013-01-01 16,584
2012: GEISINGER HEALTH SYSTEM WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 14,368
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 16,441
Number of retired or separated participants receiving benefits 2012-01-01 609
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 17,050
2011: GEISINGER HEALTH SYSTEM WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 12,720
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 13,375
Number of retired or separated participants receiving benefits 2011-01-01 638
Number of other retired or separated participants entitled to future benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 14,014
2010: GEISINGER HEALTH SYSTEM WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 12,086
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 12,037
Number of retired or separated participants receiving benefits 2010-01-01 662
Number of other retired or separated participants entitled to future benefits 2010-01-01 7
Total of all active and inactive participants 2010-01-01 12,706
2009: GEISINGER HEALTH SYSTEM WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 11,223
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 11,401
Number of retired or separated participants receiving benefits 2009-01-01 676
Number of other retired or separated participants entitled to future benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 12,080

Measure	Date	Value
2023: GEISINGER HEALTH SYSTEM WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	26,099
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	26,054
Number of retired or separated participants receiving benefits	2023-01-01	477
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	26,531
2022: GEISINGER HEALTH SYSTEM WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	24,361
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	25,515
Number of retired or separated participants receiving benefits	2022-01-01	423
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	25,938
2021: GEISINGER HEALTH SYSTEM WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	24,205
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	23,967
Number of retired or separated participants receiving benefits	2021-01-01	586
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	24,553
2020: GEISINGER HEALTH SYSTEM WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	27,064
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	23,524
Number of retired or separated participants receiving benefits	2020-01-01	687
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	24,211
2019: GEISINGER HEALTH SYSTEM WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	26,099
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	26,252
Number of retired or separated participants receiving benefits	2019-01-01	687
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	26,939
2018: GEISINGER HEALTH SYSTEM WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	25,858
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	25,500
Number of retired or separated participants receiving benefits	2018-01-01	589
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	26,089
2017: GEISINGER HEALTH SYSTEM WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	23,739
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	23,766
Number of retired or separated participants receiving benefits	2017-01-01	773
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	24,539
2016: GEISINGER HEALTH SYSTEM WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	22,289
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	22,287
Number of retired or separated participants receiving benefits	2016-01-01	708
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	22,995
2015: GEISINGER HEALTH SYSTEM WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	19,553
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	19,143
Number of retired or separated participants receiving benefits	2015-01-01	779
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	19,922
2014: GEISINGER HEALTH SYSTEM WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	16,825
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	15,865
Number of retired or separated participants receiving benefits	2014-01-01	582
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	16,447
2013: GEISINGER HEALTH SYSTEM WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	17,031
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	15,971
Number of retired or separated participants receiving benefits	2013-01-01	613
Total of all active and inactive participants	2013-01-01	16,584
2012: GEISINGER HEALTH SYSTEM WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	14,368
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	16,441
Number of retired or separated participants receiving benefits	2012-01-01	609
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	17,050
2011: GEISINGER HEALTH SYSTEM WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	12,720
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	13,375
Number of retired or separated participants receiving benefits	2011-01-01	638
Number of other retired or separated participants entitled to future benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	14,014
2010: GEISINGER HEALTH SYSTEM WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	12,086
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	12,037
Number of retired or separated participants receiving benefits	2010-01-01	662
Number of other retired or separated participants entitled to future benefits	2010-01-01	7
Total of all active and inactive participants	2010-01-01	12,706
2009: GEISINGER HEALTH SYSTEM WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	11,223
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	11,401
Number of retired or separated participants receiving benefits	2009-01-01	676
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	12,080

Form 5500 Responses for GEISINGER HEALTH SYSTEM WELFARE PLAN

2023: GEISINGER HEALTH SYSTEM WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan is a collectively bargained plan	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: GEISINGER HEALTH SYSTEM WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: GEISINGER HEALTH SYSTEM WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: GEISINGER HEALTH SYSTEM WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: GEISINGER HEALTH SYSTEM WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: GEISINGER HEALTH SYSTEM WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
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: GEISINGER HEALTH SYSTEM WELFARE 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: GEISINGER HEALTH SYSTEM WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: GEISINGER HEALTH SYSTEM WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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: GEISINGER HEALTH SYSTEM WELFARE 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 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: GEISINGER HEALTH SYSTEM WELFARE 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 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: GEISINGER HEALTH SYSTEM WELFARE 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 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: GEISINGER HEALTH SYSTEM WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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
2010: GEISINGER HEALTH SYSTEM WELFARE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GEISINGER HEALTH SYSTEM WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

00007280000

Policy instance

Insurance contract or identification number	00007280000
Number of Individuals Covered	10
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 19682 )

Policy contract number

GTA-101462

Policy instance

Insurance contract or identification number	GTA-101462
Number of Individuals Covered	26018
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $34,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	131
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	66
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK0100133

Policy instance

Insurance contract or identification number	LK0100133
Number of Individuals Covered	18792
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,273,144
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

30070090

Policy instance

Insurance contract or identification number	30070090
Number of Individuals Covered	16677
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX0980499

Policy instance

Insurance contract or identification number	FLX0980499
Number of Individuals Covered	42820
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $177,236
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DISABILITY (ACCIDENT OR S
Welfare Benefit Premiums Paid to Carrier	USD $3,544,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK0980505

Policy instance

Insurance contract or identification number	OK0980505
Number of Individuals Covered	42666
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $33,360
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $667,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK0980262

Policy instance

Insurance contract or identification number	LK0980262
Number of Individuals Covered	22453
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $242,784
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM DISABILITY BUY UP
Welfare Benefit Premiums Paid to Carrier	USD $4,855,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT0980125

Policy instance

Insurance contract or identification number	VDT0980125
Number of Individuals Covered	801
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $360,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 19682 )

Policy contract number

GTA-101462

Policy instance

Insurance contract or identification number	GTA-101462
Number of Individuals Covered	22615
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $34,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	150
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	65
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

00007280000

Policy instance

Insurance contract or identification number	00007280000
Number of Individuals Covered	8
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
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

30070090

Policy instance

Insurance contract or identification number	30070090
Number of Individuals Covered	16134
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,458,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX980499

Policy instance

Insurance contract or identification number	FLX980499
Number of Individuals Covered	43416
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $237,187
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $4,743,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $237,187
Additional information about fees paid to insurance broker	STANDARD COMMISSIONS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK980262

Policy instance

Insurance contract or identification number	LK980262
Number of Individuals Covered	22459
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $373,658
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	LONG-TERM DISABILITY CORE
Welfare Benefit Premiums Paid to Carrier	USD $7,473,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $373,658
Additional information about fees paid to insurance broker	STANDARD COMMISSIONS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT980125

Policy instance

Insurance contract or identification number	VDT980125
Number of Individuals Covered	10437
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $5,903,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK980505

Policy instance

Insurance contract or identification number	OK980505
Number of Individuals Covered	43253
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $44,665
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $893,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,665
Additional information about fees paid to insurance broker	STANDARD COMMISSIONS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 980262

Policy instance

Insurance contract or identification number	LK 980262
Number of Individuals Covered	21529
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $292,889
Total amount of fees paid to insurance company	USD $113,612
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,857,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $292,889
Amount paid for insurance broker fees	113612
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010197337

Policy instance

Insurance contract or identification number	000010197337
Number of Individuals Covered	31981
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $262,787
Total amount of fees paid to insurance company	USD $45,240
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,255,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $262,787
Amount paid for insurance broker fees	45240
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BROKER BONUS

HARTFORD LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 19682 )

Policy contract number

GTA-101462

Policy instance

Insurance contract or identification number	GTA-101462
Number of Individuals Covered	26670
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $34,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000403005011

Policy instance

Insurance contract or identification number	000403005011
Number of Individuals Covered	20971
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $31,990
Total amount of fees paid to insurance company	USD $5,550
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $639,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,990
Amount paid for insurance broker fees	5550
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BROKER BONUS

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	143
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	66
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

00007280000

Policy instance

Insurance contract or identification number	00007280000
Number of Individuals Covered	7
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
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

30070090

Policy instance

Insurance contract or identification number	30070090
Number of Individuals Covered	15757
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,389,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT980125

Policy instance

Insurance contract or identification number	VDT980125
Number of Individuals Covered	10225
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $94,867
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,800,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	94867
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 980262

Policy instance

Insurance contract or identification number	LK 980262
Number of Individuals Covered	21533
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $348,547
Total amount of fees paid to insurance company	USD $161,285
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,970,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $348,547
Amount paid for insurance broker fees	161285
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT980125

Policy instance

Insurance contract or identification number	VDT980125
Number of Individuals Covered	10828
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $133,533
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,710,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	133533
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010197337

Policy instance

Insurance contract or identification number	000010197337
Number of Individuals Covered	32160
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $289,022
Total amount of fees paid to insurance company	USD $153,681
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,780,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $240,400
Insurance broker organization code?	3
Amount paid for insurance broker fees	153681
Additional information about fees paid to insurance broker	BROKER BONUS

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB-135048

Policy instance

Insurance contract or identification number	ETB-135048
Number of Individuals Covered	26370
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $32,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000403005011

Policy instance

Insurance contract or identification number	000403005011
Number of Individuals Covered	22421
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $34,837
Total amount of fees paid to insurance company	USD $17,270
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $696,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,322
Insurance broker organization code?	3
Amount paid for insurance broker fees	17270
Additional information about fees paid to insurance broker	BROKER BONUS

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	156
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	69
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

00007280000

Policy instance

Insurance contract or identification number	00007280000
Number of Individuals Covered	5
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
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

30070090

Policy instance

Insurance contract or identification number	30070090
Number of Individuals Covered	15466
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,555,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 980262

Policy instance

Insurance contract or identification number	LK 980262
Number of Individuals Covered	23919
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $309,078
Total amount of fees paid to insurance company	USD $141,404
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,181,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $309,078
Amount paid for insurance broker fees	141404
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT980125

Policy instance

Insurance contract or identification number	VDT980125
Number of Individuals Covered	11747
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $121,252
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,274,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	121252
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010197337

Policy instance

Insurance contract or identification number	000010197337
Number of Individuals Covered	35826
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $307,974
Total amount of fees paid to insurance company	USD $208,484
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,159,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $307,974
Amount paid for insurance broker fees	208484
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB-135048

Policy instance

Insurance contract or identification number	ETB-135048
Number of Individuals Covered	26370
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $32,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000403005011

Policy instance

Insurance contract or identification number	000403005011
Number of Individuals Covered	24438
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $33,617
Total amount of fees paid to insurance company	USD $23,293
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $672,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,617
Amount paid for insurance broker fees	23293
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	181
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	73
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

00007280000

Policy instance

Insurance contract or identification number	00007280000
Number of Individuals Covered	5
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
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

30070090

Policy instance

Insurance contract or identification number	30070090
Number of Individuals Covered	16475
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,455,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT980125

Policy instance

Insurance contract or identification number	VDT980125
Number of Individuals Covered	10950
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $114,174
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,902,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	114174
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010197337

Policy instance

Insurance contract or identification number	000010197337
Number of Individuals Covered	35207
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $287,994
Total amount of fees paid to insurance company	USD $156,028
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,759,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $287,994
Amount paid for insurance broker fees	156028
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB135048

Policy instance

Insurance contract or identification number	ETB135048
Number of Individuals Covered	25500
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $32,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000403005011

Policy instance

Insurance contract or identification number	000403005011
Number of Individuals Covered	24354
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $32,684
Total amount of fees paid to insurance company	USD $18,972
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $653,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,684
Amount paid for insurance broker fees	18972
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	200
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	83
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

00007280000

Policy instance

Insurance contract or identification number	00007280000
Number of Individuals Covered	4
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
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

30070090

Policy instance

Insurance contract or identification number	30070090
Number of Individuals Covered	14620
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,153,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 980262

Policy instance

Insurance contract or identification number	LK 980262
Number of Individuals Covered	23211
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $256,109
Total amount of fees paid to insurance company	USD $117,419
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,122,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $256,109
Amount paid for insurance broker fees	117419
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3

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

Policy contract number

30070090 0001

Policy instance

Insurance contract or identification number	30070090 0001
Number of Individuals Covered	12924
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,809,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )

Policy contract number

00007280000

Policy instance

Insurance contract or identification number	00007280000
Number of Individuals Covered	4
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 980262

Policy instance

Insurance contract or identification number	LK 980262
Number of Individuals Covered	22758
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $229,124
Total amount of fees paid to insurance company	USD $199,498
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,582,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $229,124
Amount paid for insurance broker fees	199498
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT980125

Policy instance

Insurance contract or identification number	VDT980125
Number of Individuals Covered	10251
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $187,974
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,371,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	187974
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010197337

Policy instance

Insurance contract or identification number	000010197337
Number of Individuals Covered	33704
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $248,667
Total amount of fees paid to insurance company	USD $140,147
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,973,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $248,667
Amount paid for insurance broker fees	140147
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB135048

Policy instance

Insurance contract or identification number	ETB135048
Number of Individuals Covered	23766
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $1,052
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $32,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1052
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000403005011

Policy instance

Insurance contract or identification number	000403005011
Number of Individuals Covered	22865
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $30,472
Total amount of fees paid to insurance company	USD $17,166
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $609,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,472
Amount paid for insurance broker fees	17166
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	213
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	80
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 980262

Policy instance

Insurance contract or identification number	LK 980262
Number of Individuals Covered	18435
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $161,360
Total amount of fees paid to insurance company	USD $78,987
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,227,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $161,360
Amount paid for insurance broker fees	78987
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT980125

Policy instance

Insurance contract or identification number	VDT980125
Number of Individuals Covered	7638
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $68,652
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,808,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	68652
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB135048

Policy instance

Insurance contract or identification number	ETB135048
Number of Individuals Covered	20645
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $864
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $28,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	864
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010197337

Policy instance

Insurance contract or identification number	000010197337
Number of Individuals Covered	26165
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $175,507
Total amount of fees paid to insurance company	USD $108,625
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,510,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $175,507
Amount paid for insurance broker fees	108625
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

403005011

Policy instance

Insurance contract or identification number	403005011
Number of Individuals Covered	18890
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $22,199
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $443,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,199
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

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

Policy contract number

0142585

Policy instance

Insurance contract or identification number	0142585
Number of Individuals Covered	23142
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $226,291
Total amount of fees paid to insurance company	USD $49,476
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $4,213,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120,638
Amount paid for insurance broker fees	23063
Additional information about fees paid to insurance broker	BASE COMMISSIONS SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	15662
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $184,799
Total amount of fees paid to insurance company	USD $3,782
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,187,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,348
Additional information about fees paid to insurance broker	SALES AND SERVICE COMPENSATION SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	3782
Insurance broker name	AXA ASSISTANCE USA

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	12105
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,152
Total amount of fees paid to insurance company	USD $44
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $48,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $668
Additional information about fees paid to insurance broker	SALES AND SERVICE SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	44
Insurance broker name	AXA ASSISTANCE USA

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	5558
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $119,716
Total amount of fees paid to insurance company	USD $2,450
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $2,712,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,152
Additional information about fees paid to insurance broker	SALES AND SERVICE COMPENSATION SUPPLEMENTAL COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	2450
Insurance broker name	AXA ASSISTANCE USA

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )

Policy contract number

04908

Policy instance

Insurance contract or identification number	04908
Number of Individuals Covered	14782
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	5749
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $79,449
Total amount of fees paid to insurance company	USD $1,593
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $2,531,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $79,449
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Amount paid for insurance broker fees	1593
Insurance broker name	AXA ASSISTANCE USA

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	12105
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,309
Total amount of fees paid to insurance company	USD $26
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $41,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,309
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Amount paid for insurance broker fees	26
Insurance broker name	AXA ASSISTANCE USA

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	16149
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $132,629
Total amount of fees paid to insurance company	USD $2,659
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,226,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $132,629
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Amount paid for insurance broker fees	2659
Insurance broker name	AXA ASSISTANCE USA

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

101671 0140

Policy instance

Insurance contract or identification number	101671 0140
Number of Individuals Covered	1601
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,255,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

101671

Policy instance

Insurance contract or identification number	101671
Number of Individuals Covered	30971
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,612,748
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

0142585

Policy instance

Insurance contract or identification number	0142585
Number of Individuals Covered	24657
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $168,499
Total amount of fees paid to insurance company	USD $53,484
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $3,814,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $168,499
Amount paid for insurance broker fees	53484
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST NIAGRA RISK MANAGEMENT, INC.

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

Policy contract number

0142585

Policy instance

Insurance contract or identification number	0142585
Number of Individuals Covered	22168
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $190,061
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $3,316,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $160,238
Additional information about fees paid to insurance broker	BASE COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	FIRST NIAGRA RISK MANAGEMENT INC

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

101671

Policy instance

Insurance contract or identification number	101671
Number of Individuals Covered	30423
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,757,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )

Policy contract number

04908

Policy instance

Insurance contract or identification number	04908
Number of Individuals Covered	13613
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	5022
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $91,909
Total amount of fees paid to insurance company	USD $1,569
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $2,213,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,199
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Amount paid for insurance broker fees	1569
Insurance broker name	AXA ASSISTANCE USA

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	12105
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,553
Total amount of fees paid to insurance company	USD $44
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $41,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,922
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Amount paid for insurance broker fees	44
Insurance broker name	AXA ASSISTANCE USA

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	14663
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $160,841
Total amount of fees paid to insurance company	USD $2,745
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,844,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $121,099
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Amount paid for insurance broker fees	2745
Insurance broker name	AXA ASSISTANCE USA

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

Policy contract number

TM05569168

Policy instance

Insurance contract or identification number	TM05569168
Insurance policy start date	2012-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $309
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $309
Additional information about fees paid to insurance broker	BASE COMMISSION
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE BENEFIT SPECIALIST, INC.

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

101671 0118

Policy instance

Insurance contract or identification number	101671 0118
Number of Individuals Covered	2130
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,957,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	13486
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $193,951
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,407,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	12105
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD D
Welfare Benefit Premiums Paid to Carrier	USD $41,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	4317
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $1,781,143
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

0142585

Policy instance

Insurance contract or identification number	0142585
Number of Individuals Covered	20148
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $180,100
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $2,639,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

15023

Policy instance

Insurance contract or identification number	15023
Number of Individuals Covered	13466
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Welfare Benefit Premiums Paid to Carrier	USD $221,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )

Policy contract number

04908

Policy instance

Insurance contract or identification number	04908
Number of Individuals Covered	12502
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
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

TM05569168

Policy instance

Insurance contract or identification number	TM05569168
Number of Individuals Covered	130
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,060
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	83
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $15,111
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $335,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	75
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $16,597
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $367,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

101671 0118

Policy instance

Insurance contract or identification number	101671 0118
Number of Individuals Covered	1809
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,409,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

101671

Policy instance

Insurance contract or identification number	101671
Number of Individuals Covered	28314
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,953,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	12341
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $219,916
Total amount of fees paid to insurance company	USD $339
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,137,595
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

TM05569168

Policy instance

Insurance contract or identification number	TM05569168
Number of Individuals Covered	106
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,485
Total amount of fees paid to insurance company	USD $25
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GEISINGER HEALTH PLAN PA (National Association of Insurance Commissioners NAIC id number: 10244 )

Policy contract number

108733

Policy instance

Insurance contract or identification number	108733
Number of Individuals Covered	161
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $225,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	140
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $32,920
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $458,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )

Policy contract number

101671

Policy instance

Insurance contract or identification number	101671
Number of Individuals Covered	1250
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,396,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0000728000

Policy instance

Insurance contract or identification number	0000728000
Number of Individuals Covered	91
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $26,145
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $405,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

101671

Policy instance

Insurance contract or identification number	101671
Number of Individuals Covered	24374
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,556,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	47
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $17,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

49215

Policy instance

Insurance contract or identification number	49215
Number of Individuals Covered	2101
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $282,919
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,173,938
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

0142585

Policy instance

Insurance contract or identification number	0142585
Number of Individuals Covered	18055
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $94,810
Total amount of fees paid to insurance company	USD $38,132
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $2,292,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

49775

Policy instance

Insurance contract or identification number	49775
Number of Individuals Covered	93
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,481
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

44171

Policy instance

Insurance contract or identification number	44171
Number of Individuals Covered	9813
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD D
Welfare Benefit Premiums Paid to Carrier	USD $42,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GEISINGER SYSTEM SERVICES
Employer identification number (EIN):	232164794
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2015-03-04
Company Identification Number:	0802168270
Legal Registered Office Address:	1999 BRYAN ST STE 900 DALLAS United States of America (USA) 75201