401k Plan data: GROUP INSURANCE PLAN plan

GROUP INSURANCE PLAN 401k Plan overview

Plan Name	GROUP INSURANCE PLAN
Plan identification number	501

GROUP INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

FOREST CITY ENTERPRISES, INC. has sponsored the creation of one or more 401k plans.

Company Name: FOREST CITY ENTERPRISES, INC.

Employer identification number (EIN): 340863886

NAIC Classification: 531390
NAIC Description: Other Activities Related to Real Estate

Additional information about FOREST CITY ENTERPRISES, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1960-03-26

Company Identification Number: 289329

Legal Registered Office Address: 50 PUBLIC SQUARE, SUITE 1360
-
CLEVELAND
United States of America (USA)
44113

More information about FOREST CITY ENTERPRISES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 THOMAS H RIEGER EMILY HOLIDAY 2016-10-13
501 2015-01-01 THOMAS RIEGER
501 2014-01-01 THOMAS H RIEGER ANDREW PASSEN 2015-10-12
501 2014-01-01 THOMAS RIEGER
501 2013-01-01 THOMAS H RIEGER ANDREW PASSEN 2014-10-14
501 2012-01-01 THOMAS H RIEGER ANDREW PASSEN 2013-10-14
501 2011-01-01 THOMAS H RIEGER ANDREW PASSEN 2012-08-06
501 2009-06-01 THOMAS H RIEGER ANDREW J PASSEN 2010-12-22
501 2009-06-01 THOMAS H RIEGER ANDREW J PASSEN 2010-12-22
501 2009-01-01 THOMAS RIEGER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	THOMAS H RIEGER	EMILY HOLIDAY	2016-10-13
501	2015-01-01	THOMAS RIEGER
501	2014-01-01	THOMAS H RIEGER	ANDREW PASSEN	2015-10-12
501	2014-01-01	THOMAS RIEGER
501	2013-01-01	THOMAS H RIEGER	ANDREW PASSEN	2014-10-14
501	2012-01-01	THOMAS H RIEGER	ANDREW PASSEN	2013-10-14
501	2011-01-01	THOMAS H RIEGER	ANDREW PASSEN	2012-08-06
501	2009-06-01	THOMAS H RIEGER	ANDREW J PASSEN	2010-12-22
501	2009-06-01	THOMAS H RIEGER	ANDREW J PASSEN	2010-12-22
501	2009-01-01	THOMAS RIEGER

Plan Statistics for GROUP INSURANCE PLAN

401k plan membership statisitcs for GROUP INSURANCE PLAN

Measure Date Value
2015: GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2,960
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2,781
Number of retired or separated participants receiving benefits 2015-01-01 215
Total of all active and inactive participants 2015-01-01 2,996
Total participants 2015-01-01 2,996
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
2014: GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 3,040
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2,906
Number of retired or separated participants receiving benefits 2014-01-01 54
Total of all active and inactive participants 2014-01-01 2,960
Total participants 2014-01-01 2,960
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
2013: GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3,005
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,922
Number of retired or separated participants receiving benefits 2013-01-01 118
Total of all active and inactive participants 2013-01-01 3,040
Total participants 2013-01-01 3,040
2012: GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2,561
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2,960
Number of retired or separated participants receiving benefits 2012-01-01 45
Total of all active and inactive participants 2012-01-01 3,005
Total participants 2012-01-01 3,005
2011: GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,462
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2,137
Number of retired or separated participants receiving benefits 2011-01-01 424
Total of all active and inactive participants 2011-01-01 2,561
Total participants 2011-01-01 2,561
2009: GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 3,352
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 2,385
Number of retired or separated participants receiving benefits 2009-06-01 83
Total of all active and inactive participants 2009-06-01 2,468
Total participants 2009-06-01 2,468
Total participants, beginning-of-year 2009-01-01 341
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 345
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 345

Measure	Date	Value
2015: GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2,960
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2,781
Number of retired or separated participants receiving benefits	2015-01-01	215
Total of all active and inactive participants	2015-01-01	2,996
Total participants	2015-01-01	2,996
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
2014: GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	3,040
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,906
Number of retired or separated participants receiving benefits	2014-01-01	54
Total of all active and inactive participants	2014-01-01	2,960
Total participants	2014-01-01	2,960
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
2013: GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3,005
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,922
Number of retired or separated participants receiving benefits	2013-01-01	118
Total of all active and inactive participants	2013-01-01	3,040
Total participants	2013-01-01	3,040
2012: GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,561
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,960
Number of retired or separated participants receiving benefits	2012-01-01	45
Total of all active and inactive participants	2012-01-01	3,005
Total participants	2012-01-01	3,005
2011: GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,462
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,137
Number of retired or separated participants receiving benefits	2011-01-01	424
Total of all active and inactive participants	2011-01-01	2,561
Total participants	2011-01-01	2,561
2009: GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	3,352
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	2,385
Number of retired or separated participants receiving benefits	2009-06-01	83
Total of all active and inactive participants	2009-06-01	2,468
Total participants	2009-06-01	2,468
Total participants, beginning-of-year	2009-01-01	341
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	345
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	345

Form 5500 Responses for GROUP INSURANCE PLAN

2015: GROUP INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
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: GROUP INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GROUP INSURANCE 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: GROUP INSURANCE 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: GROUP INSURANCE 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
2009: GROUP INSURANCE PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Submission has been amended	Yes
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

95740-1-3

Policy instance

Insurance contract or identification number	95740-1-3
Number of Individuals Covered	172
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,173,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

3335226

Policy instance

Insurance contract or identification number	3335226
Number of Individuals Covered	1831
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $82,746
Welfare Benefit Premiums Paid to Carrier	USD $827,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,746
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CONSULTANTS AGENCY, INC.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

103291-000

Policy instance

Insurance contract or identification number	103291-000
Number of Individuals Covered	125
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $621,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

21011-0000

Policy instance

Insurance contract or identification number	21011-0000
Number of Individuals Covered	82
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $599,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AIG (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009115281

Policy instance

Insurance contract or identification number	GTP 0009115281
Number of Individuals Covered	2781
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	BUSINESS TRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $14,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREMARK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

FCERX

Policy instance

Insurance contract or identification number	FCERX
Number of Individuals Covered	1411
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Welfare Benefit Premiums Paid to Carrier	USD $2,699,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

843604

Policy instance

Insurance contract or identification number	843604
Number of Individuals Covered	650
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $29,165
Total amount of fees paid to insurance company	USD $40
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $900,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,165
Amount paid for insurance broker fees	40
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CONSULTANTS AGENCY

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1548
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $975,329
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	2248
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $15,873
Total amount of fees paid to insurance company	USD $15,886
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $800,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,873
Amount paid for insurance broker fees	15886
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	925
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,981
Total amount of fees paid to insurance company	USD $6,028
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $300,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,981
Amount paid for insurance broker fees	6028
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	50
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	P/T AD&D
Welfare Benefit Premiums Paid to Carrier	USD $24
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: 47029 )

Policy contract number

12221977 0001

Policy instance

Insurance contract or identification number	12221977 0001
Number of Individuals Covered	1383
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $225,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

21011-0000

Policy instance

Insurance contract or identification number	21011-0000
Number of Individuals Covered	45
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $703,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL16669

Policy instance

Insurance contract or identification number	HCL16669
Number of Individuals Covered	895
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $608,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

103291-000

Policy instance

Insurance contract or identification number	103291-000
Number of Individuals Covered	56
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $664,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON BEHAVIORAL SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 62221 )

Policy contract number

845316-06418

Policy instance

Insurance contract or identification number	845316-06418
Number of Individuals Covered	2906
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $50,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

95740-1-3

Policy instance

Insurance contract or identification number	95740-1-3
Number of Individuals Covered	168
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,171,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREMARK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

FCERX

Policy instance

Insurance contract or identification number	FCERX
Number of Individuals Covered	1539
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Welfare Benefit Premiums Paid to Carrier	USD $3,298,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

843604

Policy instance

Insurance contract or identification number	843604
Number of Individuals Covered	640
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $30,037
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $804,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,037
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CONSULTANTS AGENCY

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1573
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $965,532
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	951
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,009
Total amount of fees paid to insurance company	USD $5,798
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $307,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,009
Amount paid for insurance broker fees	5798
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	55
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Other welfare benefits provided	P/T AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26
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: 47029 )

Policy contract number

12221977 0001

Policy instance

Insurance contract or identification number	12221977 0001
Number of Individuals Covered	1388
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $212,369
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	2321
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $15,377
Total amount of fees paid to insurance company	USD $14,433
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $768,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,377
Amount paid for insurance broker fees	14433
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

AIG (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009115281

Policy instance

Insurance contract or identification number	GTP 0009115281
Number of Individuals Covered	2906
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Other welfare benefits provided	BUSINESS TRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $14,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL16669

Policy instance

Insurance contract or identification number	HCL16669
Number of Individuals Covered	923
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $614,531
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: 47029 )

Policy contract number

12221977 0001

Policy instance

Insurance contract or identification number	12221977 0001
Number of Individuals Covered	1362
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $194,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

95740-1-3

Policy instance

Insurance contract or identification number	95740-1-3
Number of Individuals Covered	158
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,113,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

21011-0000

Policy instance

Insurance contract or identification number	21011-0000
Number of Individuals Covered	51
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 $631,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON BEHAVIORAL SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 62221 )

Policy contract number

845316-06418

Policy instance

Insurance contract or identification number	845316-06418
Number of Individuals Covered	2985
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $40,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

103291-000

Policy instance

Insurance contract or identification number	103291-000
Number of Individuals Covered	60
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 $614,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AIG (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009115281

Policy instance

Insurance contract or identification number	GTP 0009115281
Number of Individuals Covered	2922
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Other welfare benefits provided	BUSINESS TRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $4,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREMARK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

FCERX

Policy instance

Insurance contract or identification number	FCERX
Number of Individuals Covered	1529
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Welfare Benefit Premiums Paid to Carrier	USD $2,905,883
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1639
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $957,323
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1084
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,110
Total amount of fees paid to insurance company	USD $3,793
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $311,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,110
Amount paid for insurance broker fees	3793
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	2228
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $15,291
Total amount of fees paid to insurance company	USD $9,171
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $768,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,291
Amount paid for insurance broker fees	9171
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	56
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Other welfare benefits provided	P/T AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

843604

Policy instance

Insurance contract or identification number	843604
Number of Individuals Covered	614
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $28,234
Other welfare benefits provided	ADMINISTRATION CONTRACT
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $776,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,234
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CONSULTANTS AGENCY

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	61
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $22
Other welfare benefits provided	P/T AD&D
Welfare Benefit Premiums Paid to Carrier	USD $29
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	22
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

95740-1-3

Policy instance

Insurance contract or identification number	95740-1-3
Number of Individuals Covered	155
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,176,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

21011-0000

Policy instance

Insurance contract or identification number	21011-0000
Number of Individuals Covered	54
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 $592,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON BEHAVIORAL SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 62221 )

Policy contract number

845316-06418

Policy instance

Insurance contract or identification number	845316-06418
Number of Individuals Covered	2714
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $30,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

103291-000

Policy instance

Insurance contract or identification number	103291-000
Number of Individuals Covered	66
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 $602,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AIG (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009115281

Policy instance

Insurance contract or identification number	GTP 0009115281
Number of Individuals Covered	2960
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Other welfare benefits provided	BUSINESS TRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREMARK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

FCERX

Policy instance

Insurance contract or identification number	FCERX
Number of Individuals Covered	1368
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,808,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

843604

Policy instance

Insurance contract or identification number	843604
Number of Individuals Covered	850
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $32,844
Other welfare benefits provided	ADMINISTRATION CONTRACT
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,111,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,844
Insurance broker organization code?	3
Insurance broker name	ADVANTAGE CONSULTANTS AGENCY

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1675
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $967,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL16669

Policy instance

Insurance contract or identification number	HCL16669
Number of Individuals Covered	542
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $542,508
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: 47029 )

Policy contract number

12221977 0002

Policy instance

Insurance contract or identification number	12221977 0002
Number of Individuals Covered	22
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,788
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: 47029 )

Policy contract number

12221977 0001

Policy instance

Insurance contract or identification number	12221977 0001
Number of Individuals Covered	1110
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $159,753
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	2145
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $14,953
Total amount of fees paid to insurance company	USD $6,507
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $652,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,953
Amount paid for insurance broker fees	6507
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

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

Policy contract number

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1098
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,897
Total amount of fees paid to insurance company	USD $3,034
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $291,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,897
Amount paid for insurance broker fees	3034
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOWERS WATSON DELAWARE, INC.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

21011-0000

Policy instance

Insurance contract or identification number	21011-0000
Number of Individuals Covered	53
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 $539,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

103291-000

Policy instance

Insurance contract or identification number	103291-000
Number of Individuals Covered	63
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 $555,951
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: 47029 )

Policy contract number

12221977

Policy instance

Insurance contract or identification number	12221977
Number of Individuals Covered	1302
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $155,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON BEHAVIORAL SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 62221 )

Policy contract number

06418

Policy instance

Insurance contract or identification number	06418
Number of Individuals Covered	2361
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $42,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AIG (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009115281

Policy instance

Insurance contract or identification number	GTP 0009115281
Number of Individuals Covered	3019
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	BUSINESS TRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREMARK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

FCERX

Policy instance

Insurance contract or identification number	FCERX
Number of Individuals Covered	1383
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,743,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )

Policy contract number

NJ54

Policy instance

Insurance contract or identification number	NJ54
Number of Individuals Covered	550
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,272
Other welfare benefits provided	ADMINISTRATION CONTRACT
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1636
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $940,089
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1116
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,804
Total amount of fees paid to insurance company	USD $3,096
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $364,178
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	2145
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $14,807
Total amount of fees paid to insurance company	USD $5,143
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $612,783
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	76
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $16
Other welfare benefits provided	P/T AD&D
Welfare Benefit Premiums Paid to Carrier	USD $34
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

95740-1-3

Policy instance

Insurance contract or identification number	95740-1-3
Number of Individuals Covered	165
Insurance policy start date	2011-01-31
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,195,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

843604

Policy instance

Insurance contract or identification number	843604
Number of Individuals Covered	874
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $35,971
Total amount of fees paid to insurance company	USD $55,247
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $1,042,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL16669

Policy instance

Insurance contract or identification number	HCL16669
Number of Individuals Covered	542
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $430,939
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1100
Insurance policy start date	2009-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $14,810
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $534,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )

Policy contract number

067097

Policy instance

Insurance contract or identification number	067097
Number of Individuals Covered	47
Insurance policy start date	2009-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $571,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREMARK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

FCERX

Policy instance

Insurance contract or identification number	FCERX
Number of Individuals Covered	1360
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $1,654,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

103291-000

Policy instance

Insurance contract or identification number	103291-000
Number of Individuals Covered	71
Insurance policy start date	2010-06-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $333,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

21011-0000

Policy instance

Insurance contract or identification number	21011-0000
Number of Individuals Covered	52
Insurance policy start date	2010-06-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $279,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

95740-1-3

Policy instance

Insurance contract or identification number	95740-1-3
Number of Individuals Covered	164
Insurance policy start date	2009-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,674,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00302157

Policy instance

Insurance contract or identification number	00302157
Number of Individuals Covered	35
Insurance policy start date	2009-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $308,572
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: 47029 )

Policy contract number

12221977

Policy instance

Insurance contract or identification number	12221977
Number of Individuals Covered	1086
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $150,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HORIZON BEHAVIORAL SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 62221 )

Policy contract number

06418

Policy instance

Insurance contract or identification number	06418
Number of Individuals Covered	2342
Insurance policy start date	2009-09-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $47,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AIG (National Association of Insurance Commissioners NAIC id number: 19445 )

Policy contract number

GTP 0009115281

Policy instance

Insurance contract or identification number	GTP 0009115281
Number of Individuals Covered	2054
Insurance policy start date	2009-11-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL AND ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $15,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

843604

Policy instance

Insurance contract or identification number	843604
Number of Individuals Covered	904
Insurance policy start date	2010-06-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $17,692
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $580,326
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1661
Insurance policy start date	2009-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,343,276
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL16669

Policy instance

Insurance contract or identification number	HCL16669
Number of Individuals Covered	438
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ADMINISTRATION CONTRACT
Welfare Benefit Premiums Paid to Carrier	USD $323,265
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	70
Insurance policy start date	2009-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	P/T AD&D
Welfare Benefit Premiums Paid to Carrier	USD $26
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

94958

Policy instance

Insurance contract or identification number	94958
Number of Individuals Covered	1485
Insurance policy start date	2009-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $12,500
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $802,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )

Policy contract number

NJ54

Policy instance

Insurance contract or identification number	NJ54
Number of Individuals Covered	442
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,934
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ADMINISTRATION CONTRACT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FOREST CITY ENTERPRISES, INC.
Employer identification number (EIN):	340863886
NAIC Classification:	531390
NAIC Description:	Other Activities Related to Real Estate

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1960-03-26
Company Identification Number:	289329
Legal Registered Office Address:	50 PUBLIC SQUARE, SUITE 1360 - CLEVELAND United States of America (USA) 44113