WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 401k Plan overview

Plan Name	WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC.
Plan identification number	501

WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. Benefits

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

401k Sponsoring company profile

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

Company Name:	TRANSDIGM, INC.
Employer identification number (EIN):	341750032
NAIC Classification:	336410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC.

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01	AMY PASZT	2022-07-20
501	2020-01-01	ADRIENNE MCFAYE	2021-07-23
501	2020-01-01	AMY PASZT	2022-07-20
501	2019-01-01	ADRIENNE MCFAYE	2020-08-13
501	2019-01-01	ADRIENNE MCFAYE	2021-10-19
501	2018-01-01
501	2017-01-01
501	2016-01-01	SEAN P. MARONEY
501	2015-01-01	SEAN MARONEY
501	2014-01-01	SEAN P. MARONEY
501	2013-01-01	CHRIS SWARTZ
501	2012-01-01	CHRIS SWARTZ
501	2011-01-01	JEFF KELLER
501	2009-01-01	GREGORY RUFUS		GREGORY RUFUS	2010-10-11

Plan Statistics for WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC.

401k plan membership statisitcs for WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC.

Measure	Date	Value
2022: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2022 401k membership
Total participants, beginning-of-year	2022-01-01	6,611
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	6,880
Number of retired or separated participants receiving benefits	2022-01-01	77
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	6,957
2021: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2021 401k membership
Total participants, beginning-of-year	2021-01-01	10,502
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	7,163
Number of retired or separated participants receiving benefits	2021-01-01	69
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	7,232
Number of employers contributing to the scheme	2021-01-01	0
2020: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2020 401k membership
Total participants, beginning-of-year	2020-01-01	9,202
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	6,941
Number of retired or separated participants receiving benefits	2020-01-01	3,561
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	10,502
Number of employers contributing to the scheme	2020-01-01	0
2019: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	6,096
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	6,083
Number of retired or separated participants receiving benefits	2019-01-01	138
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	6,221
Number of employers contributing to the scheme	2019-01-01	0
2018: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	5,382
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	6,049
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	6,049
2017: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	4,809
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	5,429
Number of retired or separated participants receiving benefits	2017-01-01	0
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	5,429
2016: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	4,453
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	4,809
Number of retired or separated participants receiving benefits	2016-01-01	65
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	4,874
2015: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4,636
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	4,689
Number of retired or separated participants receiving benefits	2015-01-01	79
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	4,768
2014: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4,443
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4,530
Number of retired or separated participants receiving benefits	2014-01-01	106
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	4,636
2013: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3,468
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	3,325
Number of retired or separated participants receiving benefits	2013-01-01	97
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	3,422
2012: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4,896
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4,986
Number of retired or separated participants receiving benefits	2012-01-01	41
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	5,027
2011: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,593
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4,391
Number of retired or separated participants receiving benefits	2011-01-01	62
Total of all active and inactive participants	2011-01-01	4,453
2009: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,428
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,320
Number of retired or separated participants receiving benefits	2009-01-01	83
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	1,403

Form 5500 Responses for WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC.

2022: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
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: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan 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: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
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: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 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	Yes
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: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: WELFARE BENEFIT PLAN FOR EMPLOYEES OF TRANSDIGM INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	758359
Policy instance	6
Insurance contract or identification number 758359 Number of Individuals Covered 7211 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $47,275 Total amount of fees paid to insurance company USD $110,874 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $47,275 Amount paid for insurance broker fees 110874 Additional information about fees paid to insurance broker CONTINGENT COMPENSATION Insurance broker organization code? 3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	2499855
Policy instance	5
Insurance contract or identification number 2499855 Number of Individuals Covered 289 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $66,605 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	AGC0000252428
Policy instance	4
Insurance contract or identification number AGC0000252428 Number of Individuals Covered 3598 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENT, CRITICAL ILLNESS, HOSPITAL Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $719,014 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	30061857
Policy instance	3
Insurance contract or identification number 30061857 Number of Individuals Covered 4691 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No 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	234568
Policy instance	2
Insurance contract or identification number 234568 Number of Individuals Covered 2232 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $651 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $13,123,955 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $651 Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	6091142
Policy instance	1
Insurance contract or identification number 6091142 Number of Individuals Covered 360 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $5,255 Total amount of fees paid to insurance company USD $1,327 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $72,105 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,255 Amount paid for insurance broker fees 304 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	234568
Policy instance	2
Insurance contract or identification number 234568 Number of Individuals Covered 2298 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $196,160 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,479,157 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $196,160 Amount paid for insurance broker fees 0 Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30061857
Policy instance	3
Insurance contract or identification number 30061857 Number of Individuals Covered 4631 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 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 $682,690 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	26011
Policy instance	4
Insurance contract or identification number 26011 Number of Individuals Covered 1787 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided ACCIDENT, CRITICAL ILLNESS, HOSPITAL Welfare Benefit Premiums Paid to Carrier USD $462,054 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	TRDM001
Policy instance	5
Insurance contract or identification number TRDM001 Number of Individuals Covered 6583 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 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 $65,348 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	2499855
Policy instance	6
Insurance contract or identification number 2499855 Number of Individuals Covered 323 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 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 $72,887 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	758359
Policy instance	7
Insurance contract or identification number 758359 Number of Individuals Covered 7163 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $42,158 Total amount of fees paid to insurance company USD $70,130 Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Amount paid for insurance broker fees 70130 Additional information about fees paid to insurance broker CONTINGENT COMPENSATION Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	6091142
Policy instance	1
Insurance contract or identification number 6091142 Number of Individuals Covered 339 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $6,937 Total amount of fees paid to insurance company USD $937 Other welfare benefits provided LEGAL Welfare Benefit Premiums Paid to Carrier USD $63,839 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,937 Amount paid for insurance broker fees 0 Insurance broker organization code? 3 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	234568
Policy instance	2
Insurance contract or identification number 234568 Number of Individuals Covered 2498 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $268,806 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,630,234 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $268,806 Amount paid for insurance broker fees 0 Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30061857
Policy instance	3
Insurance contract or identification number 30061857 Number of Individuals Covered 4951 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 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 $773,956 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	26011
Policy instance	4
Insurance contract or identification number 26011 Number of Individuals Covered 8703 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided ACCIDENT, CRITICAL ILLNESS, HOSPITAL Welfare Benefit Premiums Paid to Carrier USD $757,571 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	2499855
Policy instance	6
Insurance contract or identification number 2499855 Number of Individuals Covered 378 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $268 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $84,800 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $268 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	758359
Policy instance	7
Insurance contract or identification number 758359 Number of Individuals Covered 7233 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $45,010 Total amount of fees paid to insurance company USD $112,071 Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Amount paid for insurance broker fees 112071 Additional information about fees paid to insurance broker CONTINGENT COMPENSATION Insurance broker organization code? 3
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	TRDM001
Policy instance	5
Insurance contract or identification number TRDM001 Number of Individuals Covered 6924 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 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 $81,889 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	6091142
Policy instance	1
Insurance contract or identification number 6091142 Number of Individuals Covered 323 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $7,268 Total amount of fees paid to insurance company USD $1,023 Other welfare benefits provided LEGAL Welfare Benefit Premiums Paid to Carrier USD $73,260 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,095 Amount paid for insurance broker fees 0 Insurance broker organization code? 3 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GD388005451301
Policy instance	5
Insurance contract or identification number GD388005451301 Number of Individuals Covered 3639 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $26,719 Total amount of fees paid to insurance company USD $8,270 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $534,379 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,719 Amount paid for insurance broker fees 8270 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	2499855
Policy instance	1
Insurance contract or identification number 2499855 Number of Individuals Covered 437 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $3,969 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $141,022 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,969 Insurance broker organization code? 3
ADVANCE MEDICAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	TRAN36
Policy instance	9
Insurance contract or identification number TRAN36 Number of Individuals Covered 849 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EXPERT MEDICAL OPINION Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $7,263 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	22013
Policy instance	2
Insurance contract or identification number 22013 Number of Individuals Covered 2863 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $203,991 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $785,710 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $203,991 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	232827
Policy instance	4
Insurance contract or identification number 232827 Number of Individuals Covered 1605 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $186,400 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $7,925,407 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $186,400 Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30061857
Policy instance	8
Insurance contract or identification number 30061857 Number of Individuals Covered 4000 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $56,164 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $561,888 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,164 Insurance broker organization code? 3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388005451301
Policy instance	7
Insurance contract or identification number SA388005451301 Number of Individuals Covered 6301 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $142,366 Total amount of fees paid to insurance company USD $41,023 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,848,796 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $142,366 Amount paid for insurance broker fees 41023 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GF388005451301
Policy instance	6
Insurance contract or identification number GF388005451301 Number of Individuals Covered 6095 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $28,148 Total amount of fees paid to insurance company USD $8,205 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $562,952 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $28,148 Amount paid for insurance broker fees 8205 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	6091142
Policy instance	3
Insurance contract or identification number 6091142 Number of Individuals Covered 241 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $5,143 Total amount of fees paid to insurance company USD $659 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $51,372 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,143 Amount paid for insurance broker fees 659 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	22013
Policy instance	5
Insurance contract or identification number 22013 Number of Individuals Covered 2863 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $203,991 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided ACCIDENT, CRITICAL ILLNESS, HOSPITAL Welfare Benefit Premiums Paid to Carrier USD $785,710 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ADVANCE MEDICAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	TRAN36
Policy instance	10
Insurance contract or identification number TRAN36 Number of Individuals Covered 849 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided EXPERT MEDICAL OPINION Welfare Benefit Premiums Paid to Carrier USD $7,263 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388005451301
Policy instance	9
Insurance contract or identification number SA388005451301 Number of Individuals Covered 6301 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $142,366 Total amount of fees paid to insurance company USD $41,023 Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Welfare Benefit Premiums Paid to Carrier USD $2,848,796 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GF388005451301
Policy instance	8
Insurance contract or identification number GF388005451301 Number of Individuals Covered 6095 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $28,148 Total amount of fees paid to insurance company USD $8,205 Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $562,952 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GD388005451301
Policy instance	7
Insurance contract or identification number GD388005451301 Number of Individuals Covered 3639 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $26,719 Total amount of fees paid to insurance company USD $8,270 Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $534,379 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	MERECO-19
Policy instance	6
Insurance contract or identification number MERECO-19 Number of Individuals Covered 6160 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $5,914 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Welfare Benefit Premiums Paid to Carrier USD $68,746 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30061857
Policy instance	4
Insurance contract or identification number 30061857 Number of Individuals Covered 4000 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $56,164 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $561,888 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	232827
Policy instance	3
Insurance contract or identification number 232827 Number of Individuals Covered 1605 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $186,400 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,925,407 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	6091142
Policy instance	2
Insurance contract or identification number 6091142 Number of Individuals Covered 241 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $5,143 Total amount of fees paid to insurance company USD $659 Other welfare benefits provided LEGAL Welfare Benefit Premiums Paid to Carrier USD $51,372 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	2499855
Policy instance	1
Insurance contract or identification number 2499855 Number of Individuals Covered 535 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $4,983 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $144,607 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,983 Insurance broker organization code? 3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	22013
Policy instance	2
Insurance contract or identification number 22013 Number of Individuals Covered 2647 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $194,310 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $688,419 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $194,310 Insurance broker organization code? 3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	6091142
Policy instance	3
Insurance contract or identification number 6091142 Number of Individuals Covered 222 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $4,676 Total amount of fees paid to insurance company USD $702 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $47,016 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,676 Amount paid for insurance broker fees 597 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	232827
Policy instance	4
Insurance contract or identification number 232827 Number of Individuals Covered 1598 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $106,406 Total amount of fees paid to insurance company USD $7,151 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $6,387,299 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $106,406 Amount paid for insurance broker fees 7151 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GD388005451301
Policy instance	5
Insurance contract or identification number GD388005451301 Number of Individuals Covered 3135 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $25,227 Total amount of fees paid to insurance company USD $9,039 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $504,514 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $25,227 Amount paid for insurance broker fees 9039 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GF388005451301
Policy instance	6
Insurance contract or identification number GF388005451301 Number of Individuals Covered 5779 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $29,220 Total amount of fees paid to insurance company USD $10,270 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $585,768 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,220 Amount paid for insurance broker fees 10270 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388005451301
Policy instance	7
Insurance contract or identification number SA388005451301 Number of Individuals Covered 6039 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $133,737 Total amount of fees paid to insurance company USD $47,402 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,678,538 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $133,737 Amount paid for insurance broker fees 47402 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )
Policy contract number	30061857
Policy instance	8
Insurance contract or identification number 30061857 Number of Individuals Covered 3975 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $54,072 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $540,715 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $54,072 Insurance broker organization code? 3
ADVANCE MEDICAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	TRAN36
Policy instance	9
Insurance contract or identification number TRAN36 Number of Individuals Covered 820 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EXPERT MEDICAL OPINION Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $6,784 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ADVANCE MEDICAL, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	TRAN36
Policy instance	9
Insurance contract or identification number TRAN36 Number of Individuals Covered 723 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EXPERT MEDICAL OPINION Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $6,244 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	30061857
Policy instance	8
Insurance contract or identification number 30061857 Number of Individuals Covered 3557 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $50,614 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $506,136 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $50,614 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	2499855
Policy instance	1
Insurance contract or identification number 2499855 Number of Individuals Covered 401 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $2,834 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $116,421 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,834 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number	22013
Policy instance	2
Insurance contract or identification number 22013 Number of Individuals Covered 1952 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $181,323 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $608,579 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $181,323 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	6091142
Policy instance	3
Insurance contract or identification number 6091142 Number of Individuals Covered 163 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $3,542 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LEGAL Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $35,802 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,542 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	232827
Policy instance	4
Insurance contract or identification number 232827 Number of Individuals Covered 596 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $38,132 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,019,449 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $38,132 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GD388005451301
Policy instance	5
Insurance contract or identification number GD388005451301 Number of Individuals Covered 3206 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $26,010 Total amount of fees paid to insurance company USD $11,305 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $478,093 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $26,010 Amount paid for insurance broker fees 11305 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	GF388005451301
Policy instance	6
Insurance contract or identification number GF388005451301 Number of Individuals Covered 5396 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $28,253 Total amount of fees paid to insurance company USD $11,711 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $522,479 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $28,253 Amount paid for insurance broker fees 11711 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract number	SA388005451301
Policy instance	7
Insurance contract or identification number SA388005451301 Number of Individuals Covered 5603 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $131,847 Total amount of fees paid to insurance company USD $54,352 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,455,309 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $131,847 Amount paid for insurance broker fees 54352 Additional information about fees paid to insurance broker SUPPLEMENTAL COMPENSATION Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3210264
Policy instance	6
Insurance contract or identification number 3210264 Number of Individuals Covered 8287 Insurance policy start date 2015-08-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $88,362 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number	3210264
Policy instance	5
Insurance contract or identification number 3210264 Number of Individuals Covered 455 Insurance policy start date 2015-08-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,151 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,120,583 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,151 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402753G
Policy instance	4
Insurance contract or identification number 402753G Number of Individuals Covered 4698 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $40,913 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,082,948 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 40913 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION PAID Insurance broker organization code? 3 Insurance broker name MERCER HUMAN RESOURCE
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3210264
Policy instance	3
Insurance contract or identification number 3210264 Number of Individuals Covered 8175 Insurance policy start date 2014-08-01 Insurance policy end date 2015-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $218,800 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	05995A
Policy instance	1
Insurance contract or identification number 05995A Number of Individuals Covered 1 Insurance policy start date 2014-04-01 Insurance policy end date 2015-03-31 Total amount of commissions paid to insurance broker USD $4,920 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $49,204 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,920 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number	3210264
Policy instance	2
Insurance contract or identification number 3210264 Number of Individuals Covered 466 Insurance policy start date 2014-08-01 Insurance policy end date 2015-07-31 Total amount of commissions paid to insurance broker USD $7,460 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,506,480 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,460 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )
Policy contract number	30016639
Policy instance	7
Insurance contract or identification number 30016639 Number of Individuals Covered 2943 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	4
Insurance contract or identification number 203083 Number of Individuals Covered 31 Insurance policy start date 2014-01-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $550,070 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number	453
Policy instance	9
Insurance contract or identification number 453 Number of Individuals Covered 260 Insurance policy start date 2013-08-01 Insurance policy end date 2014-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No 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	05995A
Policy instance	8
Insurance contract or identification number 05995A Number of Individuals Covered 3 Insurance policy start date 2013-04-01 Insurance policy end date 2014-03-31 Total amount of commissions paid to insurance broker USD $4,514 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $45,141 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,514 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402753G
Policy instance	7
Insurance contract or identification number 402753G Number of Individuals Covered 4694 Insurance policy start date 2014-11-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $258,277 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number	3210264
Policy instance	6
Insurance contract or identification number 3210264 Number of Individuals Covered 469 Insurance policy start date 2013-08-01 Insurance policy end date 2014-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,068,901 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	30016639
Policy instance	5
Insurance contract or identification number 30016639 Number of Individuals Covered 2734 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	3
Insurance contract or identification number 203083 Number of Individuals Covered 297 Insurance policy start date 2014-01-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $322,587 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	2
Insurance contract or identification number 203083 Number of Individuals Covered 419 Insurance policy start date 2014-01-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,490,164 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	3210264
Policy instance	1
Insurance contract or identification number 3210264 Number of Individuals Covered 7932 Insurance policy start date 2013-08-01 Insurance policy end date 2014-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $7,296 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $205,212 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 7296 Additional information about fees paid to insurance broker GENERAL AGENT PAYMENTS Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )
Policy contract number	453
Policy instance	10
Insurance contract or identification number 453 Number of Individuals Covered 251 Insurance policy start date 2014-08-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	3
Insurance contract or identification number 203083 Number of Individuals Covered 0 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $264,556 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	4
Insurance contract or identification number 203083 Number of Individuals Covered 372 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $453,449 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	30016639
Policy instance	5
Insurance contract or identification number 30016639 Number of Individuals Covered 1978 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number	3210264
Policy instance	6
Insurance contract or identification number 3210264 Number of Individuals Covered 567 Insurance policy start date 2012-08-01 Insurance policy end date 2013-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,234,270 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	3210264
Policy instance	1
Insurance contract or identification number 3210264 Number of Individuals Covered 6300 Insurance policy start date 2012-08-01 Insurance policy end date 2013-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $191,057 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	2
Insurance contract or identification number 203083 Number of Individuals Covered 3325 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,263,294 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	30016639
Policy instance	6
Insurance contract or identification number 30016639 Number of Individuals Covered 1507 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	4
Insurance contract or identification number 203083 Number of Individuals Covered 3308 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $240,269 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	3
Insurance contract or identification number 203083 Number of Individuals Covered 3468 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,199,669 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	ABL662569
Policy instance	2
Insurance contract or identification number ABL662569 Number of Individuals Covered 4986 Insurance policy start date 2011-09-30 Insurance policy end date 2012-09-29 Total amount of commissions paid to insurance broker USD $123 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $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 $123 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	5
Insurance contract or identification number 203083 Number of Individuals Covered 643 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $428,133 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: N/A )
Policy contract number	3210264
Policy instance	7
Insurance contract or identification number 3210264 Number of Individuals Covered 677 Insurance policy start date 2011-08-01 Insurance policy end date 2012-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,466,172 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	3210264
Policy instance	1
Insurance contract or identification number 3210264 Number of Individuals Covered 5236 Insurance policy start date 2011-08-01 Insurance policy end date 2012-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $6,169 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $163,482 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 6169 Additional information about fees paid to insurance broker GENERAL AGENT PAYMENTS Insurance broker organization code? 3 Insurance broker name MERCER HEALTH AND BENEFITS, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )
Policy contract number	30016639
Policy instance	6
Insurance contract or identification number 30016639 Number of Individuals Covered 1233 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $4,108 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	3210264
Policy instance	1
Insurance contract or identification number 3210264 Number of Individuals Covered 4791 Insurance policy start date 2010-08-01 Insurance policy end date 2011-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $903,712 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	3
Insurance contract or identification number 203083 Number of Individuals Covered 2575 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $83,943 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,046,476 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	ABL662569
Policy instance	2
Insurance contract or identification number ABL662569 Number of Individuals Covered 4391 Insurance policy start date 2010-09-30 Insurance policy end date 2011-09-29 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $41 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	4
Insurance contract or identification number 203083 Number of Individuals Covered 2356 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $19,324 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $238,462 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	5
Insurance contract or identification number 203083 Number of Individuals Covered 1415 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $32,659 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $404,267 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	203083
Policy instance	4
Insurance contract or identification number 203083 Number of Individuals Covered 1862 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $130,705 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,307,047 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $130,705 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS LLC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	3210264
Policy instance	1
Insurance contract or identification number 3210264 Number of Individuals Covered 1590 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $813,497 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	ABL662569
Policy instance	2
Insurance contract or identification number ABL662569 Number of Individuals Covered 1483 Insurance policy start date 2009-09-30 Insurance policy end date 2010-09-29 Total amount of commissions paid to insurance broker USD $10 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	59592
Policy instance	3
Insurance contract or identification number 59592 Number of Individuals Covered 1003 Insurance policy start date 2009-12-01 Insurance policy end date 2010-11-30 Total amount of commissions paid to insurance broker USD $4,139 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $23,507 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,139 Insurance broker organization code? 3 Insurance broker name MERCER HEALTH & BENEFITS LLC

Potentially related plans

• WELFARE BENEFITS PLAN FOR EMPLOYEES OF DST INDUSTRIES, INC. [EIN = 381485636]
• WELFARE BENEFIT PLAN [EIN = 362068847]
• WELFARE BENEFITS PLAN [EIN = 510297083]
• WELFARE BENEFITS PLAN FOR ELIGIBLE EMPLOYEES OF CUSHING ACADEMY [EIN = 042104048]
• WELFARE BENEFIT PLAN [EIN = 392043844]
• WELFARE BENEFITS PLAN OF BRADLEY ARANT BOULT CUMMINGS LLP [EIN = 630243316]
• WELFARE BENEFIT PLAN [EIN = 910715309]
• WELFARE BENEFIT PLAN OF NORTHLAND CAPITAL HOLDINGS, INC. [EIN = 200222291]
• WELFARE BENEFIT PLAN OF ALORICA, INC. [EIN = 954740339]
• WELFARE BENEFIT PLAN OF RANDYS SANITATION [EIN = 411481876]
• WELFARE BENEFITS PLAN [EIN = 952156481]
• WELFARE BENEFIT PLAN [EIN = 382786141]
• WELFARE BENEFIT PLAN OF COOPER/T. SMITH CORPORATION AND AFFILIATES [EIN = 720895443]
• WELFARE BENEFIT PLAN [EIN = 411765559]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF SWEDWOOD DANVILLE LLC [EIN = 562613886]
• WELFARE BENEFIT PLAN FOR EES. OF METROPOLITAN LIFE [EIN = 135581829]
• WELFARE BENEFITS PLAN [EIN = 160723453]
• WELFARE BENEFITS PLAN [EIN = 510178661]
• WELFARE BENEFIT PLAN OF THE COUNTRY CLUB OF VIRGINIA [EIN = 540181850]
• WELFARE BENEFIT PLAN AND TRUST FOR D & M RETIREES [EIN = 356528977]
• WELFARE BENEFIT PLAN FOR EMPLOYEES UNDER A COLLECTIVE BARGAINING AGREEMENT [EIN = 273459485]
• WELFARE BENEFIT PLAN - EDUCATIONAL ASSISTANCE [EIN = 383232737]
• WELFARE BENEFIT PLAN - DISABILITY [EIN = 383232737]
• WELFARE BENEFIT PLAN OF ADVANCED TECHNOLOGY SERVICES INC [EIN = 261499204]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF PUBLIC HEALT H SOLUTIONS [EIN = 135669201]
• WELFARE BENEFIT PLAN [EIN = 043572241]
• WELFARE BENEFIT PLAN [EIN = 621498440]
• WELFARE BENEFIT PLAN FOR EMPLOYEES AND CERTAIN RETIREES OF THE KNIGHTS OF COLUMBUS [EIN = 060416470]
• WELFARE BENEFIT PLAN [EIN = 362638828]
• WELFARE BENEFITS PLAN [EIN = 621612894]
• WELFARE BENEFITS PLAN FOR UNION-REPRESENTED HOURLY EMPLOYEES OF COOPER-STANDARD AUTOMOTIVE INC. [EIN = 340549970]
• WELFARE BENEFIT PLAN FOR DURR SYSTEMS, INC. [EIN = 381961423]
• WELFARE BENEFITS PLAN FOR SALARIED AND NON-UNION HOURLY EMPLOYEES OF COOPER-STANDARD AUTOMOTIVE INC. [EIN = 340549970]
• WELFARE BENEFIT PLAN OF NOVA IC, INC. [EIN = 561699150]
• WELFARE BENEFIT PLAN [EIN = 161455134]
• WELFARE BENEFIT PLAN FOR LEE-SMITH, INC., LESCO LOGISTICS, LLC, LESCO INC. AND LYNC AMERICA LLC. [EIN = 620608217]
• WELFARE BENEFIT PLAN OF GEORGIA CROWN DISTRIBUTING CO. [EIN = 580551723]
• WELFARE BENEFIT PLAN [EIN = 250940540]
• WELFARE BENEFIT PLAN [EIN = 570945509]
• WELFARE BENEFIT PLAN [EIN = 203863475]
• WELFARE BENEFIT PLAN OF EASTER SEALS CENTRAL ILLINOIS [EIN = 370686250]
• WELFARE BENEFIT PLAN [EIN = 630338266]
• WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES COVERED UNDER A COLLECTIVE BARGAINING AGREEMENT [EIN = 273459485]
• WELFARE BENEFIT PLAN FOR USW RETIREES OF WCI STEEL [EIN = 341600163]
• WELFARE BENEFIT PLAN AND SECTION 125 CAFETERIA PLAN FOR MAVERICK USA, INC. [EIN = 710532344]
• WELFARE BENEFITS PLAN OF FORMER EMPLOYEES OF THE BUDD COMPANY AND OTHER PARTICIPATING COMPANIES [EIN = 230443060]
• WELFARE BENEFITS PLAN [EIN = 542153401]
• WELFARE BENEFIT PLAN [EIN = 271329849]
• WELFARE BENEFITS PLAN FOR RETIREES [EIN = 943019135]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF FIRMENICH, INC. [EIN = 135560633]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF BEARING DISTRIBUTORS, INC. [EIN = 570278203]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF COMMERCIAL METALS COMPANY [EIN = 750725338]
• WELFARE BENEFIT PLAN FOR OAK RIDGE ASSOCIATED UNIVERSITIES [EIN = 620476816]
• WELFARE BENEFIT PLAN FOR MAPEI CORPORATION [EIN = 363369327]
• WELFARE BENEFITS PLAN FOR EMPLOYEES OF DELEX SYSTEMS, INC. [EIN = 540836954]
• WELFARE BENEFITS PLAN [EIN = 510074302]
• WELFARE BENEFIT PLAN FOR AGENTS OF THE KNIGHTS OF COLUMBUS [EIN = 060416470]
• WELFARE BENEFIT PLAN - DENTAL [EIN = 383232737]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF CASTLE & COOKE, INC. AND PARTICIPATING DIVISIONS AND SUBSIDIARIES [EIN = 770412800]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF SAFERACK, LLC [EIN = 200173105]
• WELFARE BENEFIT PLAN FOR HONEY FARMS, INC. EMPLOYEES [EIN = 042453813]
• WELFARE BENEFITS PLAN FOR RETIREES OF CONTINENTAL - RUBBER [EIN = 341417030]
• WELFARE BENEFIT PLAN - LIFE INSURANCE [EIN = 383232737]
• WELFARE BENEFIT PLAN [EIN = 223807370]
• WELFARE BENEFIT PLAN [EIN = 593784062]
• WELFARE BENEFITS - HEALTH [EIN = 841475486]
• WELFARE BENEFIT PLAN OF NEIGHBORHOOD LEGAL SERVICE OF LOS ANGELES COUNTY [EIN = 952408642]
• WELFARE BENEFIT PLAN [EIN = 390379990]
• WELFARE BENEFIT PLAN OF NEW YORK STOCK EXCHANGE [EIN = 205474429]
• WELFARE BENEFIT PLAN [EIN = 381659835]
• WELFARE BENEFIT PLAN OF THOMAS PUBLISHING [EIN = 134219818]
• WELFARE BENEFIT PROGRAM FOR EMPLOYEES OF ARMSTRONG WORLD INDUSTRIES, INC. [EIN = 230366390]
• WELFARE BENEFIT PLAN [EIN = 042505372]
• WELFARE BENEFIT [EIN = 208550301]
• WELFARE BENEFIT PROGRAMS [EIN = 593228107]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF HEADWAY TECHNOLOGIES, INC. [EIN = 770383260]
• WELFARE BENEFIT PLAN OF CHILDRENS' SURGICAL ASSOCIATES LTD. [EIN = 232589322]
• WELFARE BENEFITS PLAN OF UNITED CEREBRAL PALSY ASSOCIATION OF NIAGARA COUNTY [EIN = 160786061]
• WELFARE BENEFITS PLAN [EIN = 223800664]
• WELFARE BENEFITS PLAN FOR ROARING SPRING BLANK BOOK COMPANY [EIN = 231023880]
• WELFARE BENEFIT PLAN [EIN = 341854038]
• WELFARE BENEFITS PLAN OF EAST HOUSE CORPORATION [EIN = 160926404]
• WELFARE BENEFIT PLAN OF ALOHA MANAGMENT CO AND ALOHA NURSING REHAB CENTRE [EIN = 990277222]
• WELFARE BENEFITS PLAN [EIN = 010346051]
• WELFARE BENEFIT PLAN - SEVERANCE [EIN = 383232737]
• WELFARE BENEFIT PLANS [EIN = 043593886]
• WELFARE BENEFITS - LIFE AND ADD INSURANCE [EIN = 841475486]
• WELFARE BENEFIT PLAN OF ELECTRONICS RESEARCH, INC. [EIN = 351083384]
• WELFARE BENEFITS PLAN [EIN = 320030329]
• WELFARE BENEFIT PLAN - LIFE - BTRM [EIN = 161280696]
• WELFARE BENEFIT PLAN - TRAVEL INSURANCE [EIN = 383232737]
• WELFARE BENEFIT PLAN [EIN = 202076564]
• WELFARE BENEFIT PLAN [EIN = 314333125]
• WELFARE BENEFIT PLAN [EIN = 464327167]
• WELFARE BENEFITS PLAN FOR HOURLY RETIREES OF WHITE PINE COPPER DIVISION/COPPER RANGE COMPANY [EIN = 730400345]
• WELFARE BENEFIT PLAN GROUP HEALTH, LIFE, LTD [EIN = 371173264]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF BCD TRAVEL USA LLC [EIN = 582308827]
• WELFARE BENEFIT PLAN OF YAKIMA NEIGHBORHOOD HEALTH SERVICES [EIN = 910928817]
• WELFARE BENEFITS PLAN FOR EMPLOYEES OF CONTINENTAL-AUTOMOTIVE SYSTEMS [EIN = 510304065]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF LUBBOCK NATIONAL BANK [EIN = 751615725]
• WELFARE BENEFITS FOR EMPLOYEES/DEPENDENTS IN ALL CLASSES OF STANDARD MORTGAGE CORPORATION [EIN = 720593959]
• WELFARE BENEFITS PLAN FOR EMPLOYEES OF PLUNKETT COONEY, P.C. [EIN = 381896842]
• WELFARE BENEFITS PLAN [EIN = 221492756]
• WELFARE BENEFIT PLAN [EIN = 752949425]
• WELFARE BENEFIT PLAN - RETIREE HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 383232737]
• WELFARE BENEFIT PLAN-PRINCIPAL [EIN = 363778178]
• WELFARE BENEFIT PLAN [EIN = 222529464]
• WELFARE BENEFIT PLAN FOR ELIGIBLE EMPLOYEES OF VERMONT ELECTRIC POWER COMPANY [EIN = 030195580]
• WELFARE BENEFITS PLAN OF NEC CORPORATION OF AMERICA AND ITS AFFILIATES [EIN = 200665337]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF THE AMWAY HOTEL CORPORATION [EIN = 382239010]
• WELFARE BENEFIT PLAN - ACCIDENTAL DEATH & DISMEMBERMENT [EIN = 383232737]
• WELFARE BENEFIT PLAN OF COMMUNITY LINK, INC. [EIN = 370955971]
• WELFARE BENEFITS PLAN [EIN = 043402944]
• WELFARE BENEFIT PLAN OF UNITED HARDWARE DISTRIBUTING CO. [EIN = 410640978]
• WELFARE BENEFIT PLAN - ADD - BAS [EIN = 161280696]
• WELFARE BENEFITS PLAN FOR RETIREES OF CONTINENTAL - AUTOMOTIVE SYSTEMS [EIN = 510304065]
• WELFARE BENEFIT PLAN [EIN = 541876990]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF VILLAGER CONSTRUCTION, INC. [EIN = 161146699]
• WELFARE BENEFITS PLANS OF PLANNED PARENTHOOD MINNESOTA, NORTH DAKOTA, SOUTH DAKOTA [EIN = 410948382]
• WELFARE BENEFIT PLAN [EIN = 237353508]
• WELFARE BENEFIT PLAN - NON-OCCUPATIONAL TEMPORARY DISABILITY INSURANCE PLAN [EIN = 660219759]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF SUIT-KOTE CORPORATION [EIN = 161177189]
• WELFARE BENEFIT PLAN FOR CIC GROUP, INC. [EIN = 460509421]
• WELFARE BENEFITS PLAN [EIN = 160837866]
• WELFARE BENEFIT PLAN [EIN = 953480714]
• WELFARE BENEFIT PLAN FOR HOME OFFICE EMPLOYEES [EIN = 350145825]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF MARKI'S, INC. DBA LANDMARK ENTERPRISES [EIN = 161289457]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF DUGGAN & DUGGAN [EIN = 161368369]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF DELALIO SOUTH FORK ASPHALT [EIN = 112348790]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF VISONE CONSTRUCTION, INC. [EIN = 161320950]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF A. TREFFEISEN & SON, LLC [EIN = 161590910]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF COVERCO, INC. [EIN = 161011735]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NORTHEAST PAVING DIVISION OF NORTHEAST DIVERSIFICATION, INC. [EIN = 161147979]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF MCPHERSON BUILDERS, INC. [EIN = 160997523]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF MUNICIPAL MILLING & MAINTENANCE LLC [EIN = 274612965]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF FREDERICO CONSTRUCTION & DEMOLITION, LLC [EIN = 208934007]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF H & K SERVICES, INC [EIN = 161607770]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF LRS EXCAVATING, INC. [EIN = 160985468]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF LECLAIRE-FLEMING MECHANICAL CONTRACTORS, INC. [EIN = 161322614]
• WELFARE BENEFIT PLAN FOR LIEBEN, WHITTED, HOUGHTON, SLOWIACZEK & CAVANAGH, P.C., L.L.O. [EIN = 470721732]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF WIND-SUN CONSTRUCTION COMPANY, INC. [EIN = 161367723]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF GYM DOOR REPAIRS, INC. [EIN = 112418984]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF M.L. CACCAMISE ELECTRIC CORPORATION [EIN = 161469532]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NAGAN CONSTRUCTION, INC. [EIN = 112926914]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF DAY AUTOMATION SYSTEMS, INC. [EIN = 161576146]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF EMPIRE ERECTORS, INC. [EIN = 161453443]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JAVEN CONSTRUCTION CO., INC. [EIN = 161177303]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ROSEMAR CONSTRUCTION, INC. [EIN = 112895967]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF F.G. RAYBURN MASON CONTRACTORS, INC. [EIN = 161363162]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RANDSCO PIPELINE, INC. [EIN = 161160897]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF THEATRICAL SERVICES AND SUPPLIES, INC. [EIN = 112196418]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ANNSEAL, INC. [EIN = 030435899]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF BON-TON OF SYRACUSE, INC. [EIN = 161131435]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF THE CONSOLIDATED BUILDING CONTRACTORS [EIN = 800441228]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF OCCHINO CORP [EIN = 160835935]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF DON TANGUAY, INC. [EIN = 481285288]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RILEY EXCAVATING & CONTRACTING, INC. [EIN = 112648930]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF MACEDON EXCAVATING AND PAVING, INC. [EIN = 161008036]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF ALLTEK ENERGY SYSTEMS, INC. [EIN = 141620911]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF C.O. FALTER CONSTRUCTION CORP [EIN = 160968314]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF TERSAL CONSTRUCTION SERVICES, INC. [EIN = 161439733]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF TOWER ROOFING COMPANY, INC. [EIN = 161566753]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF INTER CONNECTION ELECTRIC, INC. [EIN = 113027956]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ALEXSCOE, LLC DBA ATLAS FENCE [EIN = 454182606]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF LAKESTONE DEVELOPMENT, INC. [EIN = 161597003]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF AB CONSTRUCTION AND ROOFING INC. [EIN = 161492423]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF EMPIRE STATE MERIT APPRENTICESHIP ALLIANCE, INC. [EIN = 208482142]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF LUCK BROTHERS, INC. [EIN = 141509121]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF SJ HOERNING CONSTRUCTION, INC. [EIN = 113452378]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ORCHARD EARTH & PIPE CORP. [EIN = 161140507]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF AAA CARTING & RUBBISH REMOVAL, INC. [EIN = 134068572]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RELLE ELECTRIC CORP., INC. [EIN = 113510841]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF REAL DEPENDABLE CONTRACTING CORP. [EIN = 113637290]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF HYNES CONCRETE CONTRACTOR, INC. [EIN = 161085101]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JC INSULATION SERVICES, INC. [EIN = 454002788]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF GALLO CONSTRUCTION CORPORATION [EIN = 141454116]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF HR ENVIRONMENTAL CONTRACTING, INC. [EIN = 264055723]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF RYMAR ELECTRIC [EIN = 271418221]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CONCEPT CONSTRUCTION CORPORATION [EIN = 161469309]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF GDH CONSTRUCTION, INC. [EIN = 161181096]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ATLAS FENCE, INC. [EIN = 161121614]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NORTHERN GLASS CO., INC. [EIN = 161134337]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF EMPIRE INSULATION SPECIALTIES, INC. [EIN = 141787956]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF ENVIRONMENTAL CONSTRUCTION GROUP [EIN = 203796829]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF SEAWAY EARTH & PIPE, LLC [EIN = 273635043]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF COPELAND COATING, CO., INC. [EIN = 141562182]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF FEHER RUBBISH REMOVAL, INC. [EIN = 161123509]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF HAN-TEK, INC. [EIN = 161155127]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF MEYER CONTRACTING CORPORATION [EIN = 141693847]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF BIG ANT ELECTRIC, INC. [EIN = 113538109]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF KIMIL CONSTRUCTION, INC. [EIN = 161376982]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF A-TEAM REMEDIATION [EIN = 461126904]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF GLOBAL CONTRACTING & PAINTING, INC. [EIN = 161396911]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JD NORTHRUP CONSTRUCTION, INC. [EIN = 161024841]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF RADEC CORPORATION [EIN = 161006601]
• WELFARE BENEFITS FOR EMPLOYEES AT RICHLAND CENTER [EIN = 391017450]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY GENERAL HOSPITAL [EIN = 150622506]
• WELFARE BENEFITS - VISION [EIN = 841475486]
• WELFARE BENEFIT PLAN OF BEHAVIORAL CONNECTIONS OF WOOD CO [EIN = 341262376]
• WELFARE BENEFITS - DENTAL [EIN = 841475486]
• WELFARE BENEFITS PLAN OF SPARKS HEALTH SYSTEM [EIN = 710846701]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF PHOEBE- DEVITT HOMES [EIN = 231396838]
• WELFARE BENEFIT PROGRAMS [EIN = 411981625]
• WELFARE BENEFIT PLAN [EIN = 942147007]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF ANDERSON GROUP [EIN = 510332265]
• WELFARE BENEFIT PLAN [EIN = 952108010]
• WELFARE BENEFITS PLAN FOR HCL AMERICA EMPLOYEES [EIN = 770205035]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF PUBLIC HEALTH SOLUTIONS [EIN = 135669201]
• WELFARE BENEFIT PLAN [EIN = 581409385]
• WELFARE BENEFIT PLAN - MEDICAL [EIN = 383232737]
• WELFARE BENEFIT PLAN FOR NON-TENNESSEE EMPLOYEES [EIN = 621727563]
• WELFARE BENEFIT PLAN [EIN = 381629793]
• WELFARE BENEFIT PLAN OF CHRISTENSEN OCONNOR JOHNSON KINDNESS PLLC [EIN = 910860813]
• WELFARE BENEFIT PLAN [EIN = 362897326]
• WELFARE BENEFITS PLAN FOR CHAMPION SOLUTIONS GROUP [EIN = 592347579]
• WELFARE BENEFIT PLAN - LIF824175 [EIN = 161280696]
• WELFARE BENEFIT PLAN [EIN = 262878524]
• WELFARE BENEFITS PLAN FOR EMPLOYEES OF CONTINENTAL - RUBBER [EIN = 341417030]
• WELFARE BENEFIT PLAN [EIN = 364215970]
• WELFARE BENEFITS WRAP PLAN [EIN = 621554972]
• WELFARE BENEFIT PLAN [EIN = 430654874]
• WELFARE BENEFIT PLAN OF LEGAL ASSISTANCE OF WESTERN NEW YORK, INC. [EIN = 160955954]
• WELFARE BENEFIT PLAN [EIN = 753078675]
• WELFARE BENEFIT PLAN OF CITY UNIVERSITY [EIN = 237421224]
• WELFARE BENEFIT PROGRAM FOR RETIREES OF ARMSTRONG WORLD INDUSTRIES, INC. [EIN = 230366390]
• WELFARE BENEFIT PROGRAM FOR RETIREES OF ARMSTRONG FLOORING, INC. [EIN = 474303305]
• WELFARE BENEFITS OF UNIVERSAL INSURANCE COMPANY [EIN = 660313825]
• WELFARE BENEFIT PLAN OF NUSS TRUCK GROUP INC. [EIN = 411364452]
• WELFARE BENEFITS PROGRAM [EIN = 540969072]
• WELFARE BENEFIT PLAN [EIN = 410600750]
• WELFARE BENEFIT PROGRAM FOR EMPLOYEES OF ARMSTRONG FLOORING, INC. [EIN = 474303305]
• WELFARE BENEFIT PLAN FOR AGENTS [EIN = 350145825]
• WELFARE BENEFIT WRAP PROGRAM [EIN = 453797665]
• WELFARE BENEFIT FOR EMPLOYEES OF LAVA SCS, LLC AND DIVERSIFIED OUTSOURCE SERVICES [EIN = 270885109]
• WELFARE BENEFIT PLAN [EIN = 300802612]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF DC 37 HEALTH & SECURITY PLAN [EIN = 136209963]
• WELFARE BENEFITS PLAN [EIN = 042108376]
• WELFARE BENEFIT PLAN FOR FEEDING AMERICA EMPLOYEES [EIN = 363673599]
• WELFARE BENEFITS PLAN FOR ELIGIBLE EMPLOYEES OF THYSSEN KRUPP ACCESS [EIN = 431861064]
• WELFARE BENEFIT WRAP PROGRAM [EIN = 631047498]
• WELFARE BENEFIT WRAP PLAN [EIN = 454454484]
• WELFARE BENEFIT PLAN [EIN = 942248390]
• WELFARE BENEFITS PLAN FOR EMPLOYEES OF GARDEN CITY HOSPITAL [EIN = 381358390]
• WELFARE BENEFIT PLAN OF ORTHOPAEDIC SPECIALISTS OF THE CAROLINAS PA [EIN = 561999435]
• WELFARE BENEFIT PLAN-PRINCIPAL [EIN = 363779178]
• WELFARE BENEFIT PLAN OF LIFECORE BIOMEDICAL, LLC. [EIN = 410948334]
• WELFARE BENEFIT PLAN [EIN = 760396399]
• WELFARE BENEFIT PLAN OF TIC MAINTENANCE AND SUBSIDIARIES [EIN = 200889606]
• WELFARE BENEFIT PLAN OF SATYAM COMPUTER SERVICES [EIN = 232708334]
• WELFARE BENEFIT PLAN OF ENVIRONMENTAL FLTRATION TECHNOLOGIES LLC [EIN = 562068002]
• WELFARE BENEFIT PLAN [EIN = 953062936]
• WELFARE BENEFIT PLAN [EIN = 391877511]
• WELFARE BENEFIT PLAN [EIN = 382724516]
• WELFARE BENEFIT PLAN - LIFE INSURANCE [EIN = 237444497]
• WELFARE BENEFIT PLAN FOR SALARIED EMPLOYEES OF ERAMET MARIETTA, INC. [EIN = 980201165]
• WELFARE BENEFIT PLAN - DENTAL INSURANCE [EIN = 237444497]
• WELFARE BENEFIT PLAN - HEALTH INSURANCE [EIN = 237444497]
• WELFARE BENEFIT PLAN [EIN = 382756467]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF WEIR AMERICAN HYDRO CORPORATION [EIN = 232426636]
• WELFARE BENEFIT PLAN [EIN = 204011368]
• WELFARE BENEFITS TR FOR SALARY & HOURLY RETIREES OF SWEDISH MATCH [EIN = 826774663]
• WELFARE BENEFITS TR FOR UNION RETIREES OF SWEDISH MATCH [EIN = 826773585]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NORTHERN PAVING LLC [EIN = 815298395]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF U.A. CONSTRUCTION CORPORATION [EIN = 133942105]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CRAFCO, INC. [EIN = 860324978]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NORTHLAND ASSOCIATES, INC. [EIN = 161186414]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF JDS CONSTRUCTION DIV. OF NORTHLAND ASSOCIATES, INC. [EIN = 161186414]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF POWER-UP ELECTRICAL CONTRACTING CORP. [EIN = 112793436]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF NAGLE SEAL COATING, INC. [EIN = 161412023]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CALLEA ELECTRIC, INC. [EIN = 161442603]
• WELFARE BENEFIT PLAN [EIN = 840914717]
• WELFARE BENEFIT PLAN FOR SKINNER MANAGEMENT COMPANY [EIN = 593161650]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF EPIC CONTRACTING, INC. [EIN = 205274868]
• WELFARE BENEFITS PLAN & TRUST [EIN = 381998421]
• WELFARE BENEFIT PLAN FOR EMPLOYEES OF DOLOMITE PRODUCTS COMPANY, INC. [EIN = 160410930]
• WELFARE BENEFIT PLAN OF ADVANCED TECHNOLOGY SERVICES INC [EIN = 371174273]
• WELFARE BENEFIT PLAN [EIN = 990282163]
• WELFARE BENEFIT PLAN [EIN = 112277818]
• WELFARE BENEFIT PLAN OF ROBINSON & COLE [EIN = 060512640]
• WELFARE BENEFIT PLAN [EIN = 382113393]
• WELFARE BENEFIT PLAN FOR EMPLOYEE OF PUBLIC HEALTH SOLUTIONS [EIN = 135669201]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF S&O CONSTRUCTION SERVICES, INC. [EIN = 141690439]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF 716 SITE CONTRACTING, INC. [EIN = 473223000]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF MORSCH PIPELINE, INC.. [EIN = 453824358]
• WELFARE BENEFIT PLAN [EIN = 942176054]
• WELFARE BENEFIT PLAN [EIN = 204224643]
• WELFARE BENEFIT PLANS TRUST [EIN = 943274043]
• WELFARE BENEFIT PLAN [EIN = 593653838]
• WELFARE BENEFITS OF HR PROPERTIES INC DBA [EIN = 660601640]
• WELFARE BENEFIT PLAN [EIN = 208955304]
• WELFARE BENEFIT PLAN [EIN = 590673146]
• WELFARE BENEFIT PLAN [EIN = 392002752]
• WELFARE BENEFIT PLAN [EIN = 832134609]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF CMM SITEWORK, INC. [EIN = 202744632]
• WELFARE BENEFITS [EIN = 562465023]
• WELFARE BENEFIT PLAN IAR, INC. [EIN = 202288072]
• WELFARE BENEFIT PLAN [EIN = 381996193]
• WELFARE BENEFIT PLAN [EIN = 381996193]
• WELFARE BENEFIT PLAN [EIN = 832986435]
• WELFARE BENEFIT PLAN [EIN = 030212129]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF MAINSTREAM ELECTRIC, INC. [EIN = 133802153]
• WELFARE BENEFIT PLAN [EIN = 850199988]
• WELFARE BENEFITS PLAN FOR THE EMPLOYEES OF BENIMAX, INC. [EIN = 273269220]
• WELFARE BENEFIT PLAN [EIN = 743169328]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF SENECA STONE CORP. [EIN = 161124518]
• WELFARE BENEFITS PLAN OF GREYSTONE HEALTHCARE MANAGEMENT - MIDWEST LLC [EIN = 843875699]
• WELFARE BENEFIT OF HIAWATHA VALLEY MENTAL HEALTH CENTER [EIN = 410889423]
• WELFARE BENEFIT PLAN [EIN = 010931061]
• WELFARE BENEFIT PLAN - RETIREE HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 323232737]
• WELFARE BENEFIT PLAN [EIN = 821408778]
• WELFARE BENEFIT PLAN [EIN = 273498190]
• WELFARE BENEFIT PLAN [EIN = 860865357]
• WELFARE BENEFIT PLAN [EIN = 580623571]
• WELFARE BENEFITS PLAN OF ABLEHEARTS HEALTHCARE FOUNDATION [EIN = 204137987]
• WELFARE BENEFIT PLAN [EIN = 475138029]
• WELFARE BENEFIT PLAN - LIFE & AD&D [EIN = 475138029]
• WELFARE BENEFIT PLAN [EIN = 841307530]
• WELFARE BENEFIT PLAN [EIN = 821317953]
• WELFARE BENEFIT PLAN [EIN = 881708677]
• WELFARE BENEFIT PLANS OF PLANNED PARENTHOOD NORTH CENTRAL STATES [EIN = 830614523]
• WELFARE BENEFIT PLAN [EIN = 160775330]
• WELFARE BENEFIT PLAN BASIC GROUP AD&D [EIN = 810948786]
• WELFARE BENEFIT PLAN BASIC LIFE & SUPPLEMENTAL LIFE [EIN = 810948786]
• WELFARE BENEFIT PLAN DENTAL [EIN = 810948786]
• WELFARE BENEFIT PLAN LONG TERM DISABILITY [EIN = 810948786]
• WELFARE BENEFIT PLAN MEDICAL [EIN = 810948786]
• WELFARE BENEFIT PLAN SHORT TERM DISABILITY [EIN = 810948786]
• WELFARE BENEFIT PLAN VISION [EIN = 810948786]
• WELFARE BENEFIT PLAN [EIN = 204467006]
• WELFARE BENEFIT PLAN OF THE COOPER GROUP INC AND AFFILIATES [EIN = 850871337]
• WELFARE BENEFIT PLAN FOR THE EMPLOYEES OF PILON CONSTRUCTION CO., INC. [EIN = 160997428]