401k Plan data: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN plan

UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 401k Plan overview

Plan Name	UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN
Plan identification number	504

UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

UNIVERSITY OF NOTRE DAME DU LAC has sponsored the creation of one or more 401k plans.

Company Name: UNIVERSITY OF NOTRE DAME DU LAC

Employer identification number (EIN): 350868188

NAIC Classification: 611000

Additional information about UNIVERSITY OF NOTRE DAME DU LAC

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs

Incorporation Date:

Company Identification Number: 902916

More information about UNIVERSITY OF NOTRE DAME DU LAC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-01-01
504 2021-01-01
504 2020-01-01
504 2019-01-01
504 2018-01-01
504 2017-01-01 ROBERT MCQUADE JOHN AFFLECK-GRAVES 2018-07-27
504 2016-01-01 ROBERT MCQUADE JOHN AFFLECK-GRAVES 2017-07-17
504 2015-01-01 ROBERT MCQUADE JOHN AFFLECK-GRAVES 2016-09-15
504 2014-01-01 ROBERT MCQUADE JOHN AFFLECK-GRAVES 2015-07-28
504 2013-01-01 ROBERT MCQUADE JOHN AFFLECK-GRAVES 2014-07-25
504 2012-01-01 ROBERT MCQUADE JOHN AFFLECK-GRAVES 2013-07-30
504 2011-01-01 ROBERT MCQUADE JOHN AFFLECK-GRAVES 2012-08-20
504 2009-01-01 ROBERT MCQUADE

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01
504	2021-01-01
504	2020-01-01
504	2019-01-01
504	2018-01-01
504	2017-01-01	ROBERT MCQUADE	JOHN AFFLECK-GRAVES	2018-07-27
504	2016-01-01	ROBERT MCQUADE	JOHN AFFLECK-GRAVES	2017-07-17
504	2015-01-01	ROBERT MCQUADE	JOHN AFFLECK-GRAVES	2016-09-15
504	2014-01-01	ROBERT MCQUADE	JOHN AFFLECK-GRAVES	2015-07-28
504	2013-01-01	ROBERT MCQUADE	JOHN AFFLECK-GRAVES	2014-07-25
504	2012-01-01	ROBERT MCQUADE	JOHN AFFLECK-GRAVES	2013-07-30
504	2011-01-01	ROBERT MCQUADE	JOHN AFFLECK-GRAVES	2012-08-20
504	2009-01-01	ROBERT MCQUADE

Plan Statistics for UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN

401k plan membership statisitcs for UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN

Measure Date Value
2022: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 6,569
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 6,116
Number of retired or separated participants receiving benefits 2022-01-01 720
Total of all active and inactive participants 2022-01-01 6,836
2021: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 6,700
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 5,879
Number of retired or separated participants receiving benefits 2021-01-01 715
Total of all active and inactive participants 2021-01-01 6,594
2020: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 6,743
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 5,960
Number of retired or separated participants receiving benefits 2020-01-01 754
Total of all active and inactive participants 2020-01-01 6,714
2019: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 6,990
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 5,969
Number of retired or separated participants receiving benefits 2019-01-01 783
Total of all active and inactive participants 2019-01-01 6,752
2018: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 6,705
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 6,199
Number of retired or separated participants receiving benefits 2018-01-01 797
Total of all active and inactive participants 2018-01-01 6,996
2017: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 6,537
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 5,917
Number of retired or separated participants receiving benefits 2017-01-01 826
Total of all active and inactive participants 2017-01-01 6,743
2016: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 6,362
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 5,756
Number of retired or separated participants receiving benefits 2016-01-01 778
Total of all active and inactive participants 2016-01-01 6,534
2015: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 6,219
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 5,586
Number of retired or separated participants receiving benefits 2015-01-01 770
Total of all active and inactive participants 2015-01-01 6,356
2014: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 6,215
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 5,454
Number of retired or separated participants receiving benefits 2014-01-01 795
Total of all active and inactive participants 2014-01-01 6,249
2013: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 5,130
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5,268
Number of retired or separated participants receiving benefits 2013-01-01 24
Total of all active and inactive participants 2013-01-01 5,292
2012: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4,762
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 4,981
Number of retired or separated participants receiving benefits 2012-01-01 21
Total of all active and inactive participants 2012-01-01 5,002
2011: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 4,568
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4,798
Number of retired or separated participants receiving benefits 2011-01-01 16
Total of all active and inactive participants 2011-01-01 4,814
2009: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4,983
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4,585
Number of retired or separated participants receiving benefits 2009-01-01 543
Total of all active and inactive participants 2009-01-01 5,128

Measure	Date	Value
2022: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	6,569
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	6,116
Number of retired or separated participants receiving benefits	2022-01-01	720
Total of all active and inactive participants	2022-01-01	6,836
2021: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	6,700
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	5,879
Number of retired or separated participants receiving benefits	2021-01-01	715
Total of all active and inactive participants	2021-01-01	6,594
2020: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	6,743
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	5,960
Number of retired or separated participants receiving benefits	2020-01-01	754
Total of all active and inactive participants	2020-01-01	6,714
2019: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	6,990
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	5,969
Number of retired or separated participants receiving benefits	2019-01-01	783
Total of all active and inactive participants	2019-01-01	6,752
2018: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	6,705
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	6,199
Number of retired or separated participants receiving benefits	2018-01-01	797
Total of all active and inactive participants	2018-01-01	6,996
2017: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	6,537
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	5,917
Number of retired or separated participants receiving benefits	2017-01-01	826
Total of all active and inactive participants	2017-01-01	6,743
2016: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	6,362
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	5,756
Number of retired or separated participants receiving benefits	2016-01-01	778
Total of all active and inactive participants	2016-01-01	6,534
2015: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	6,219
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	5,586
Number of retired or separated participants receiving benefits	2015-01-01	770
Total of all active and inactive participants	2015-01-01	6,356
2014: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	6,215
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5,454
Number of retired or separated participants receiving benefits	2014-01-01	795
Total of all active and inactive participants	2014-01-01	6,249
2013: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	5,130
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5,268
Number of retired or separated participants receiving benefits	2013-01-01	24
Total of all active and inactive participants	2013-01-01	5,292
2012: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4,762
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4,981
Number of retired or separated participants receiving benefits	2012-01-01	21
Total of all active and inactive participants	2012-01-01	5,002
2011: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	4,568
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4,798
Number of retired or separated participants receiving benefits	2011-01-01	16
Total of all active and inactive participants	2011-01-01	4,814
2009: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4,983
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4,585
Number of retired or separated participants receiving benefits	2009-01-01	543
Total of all active and inactive participants	2009-01-01	5,128

Form 5500 Responses for UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN

2022: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: UNIVERSITY OF NOTRE DAME DU LAC GROUP BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	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

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	312
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $430,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

72325-8

Policy instance

Insurance contract or identification number	72325-8
Number of Individuals Covered	1418
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,590
Total amount of fees paid to insurance company	USD $12,506
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $208,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	12506
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $11,672

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889831001

Policy instance

Insurance contract or identification number	98889831001
Number of Individuals Covered	85
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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 $8,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889751001

Policy instance

Insurance contract or identification number	98889751001
Number of Individuals Covered	10005
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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 $819,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	6984
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5405
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6588
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,399,015
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

06946A

Policy instance

Insurance contract or identification number	06946A
Number of Individuals Covered	46
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION/REPATRIATION COV.
Welfare Benefit Premiums Paid to Carrier	USD $333,707
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

758370

Policy instance

Insurance contract or identification number	758370
Number of Individuals Covered	4990
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $69,374
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	69374
Additional information about fees paid to insurance broker	BROKERAGE FEE
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

72325-8

Policy instance

Insurance contract or identification number	72325-8
Number of Individuals Covered	5104
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $25,849
Total amount of fees paid to insurance company	USD $18,695
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $233,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,175
Insurance broker organization code?	3
Amount paid for insurance broker fees	18695
Additional information about fees paid to insurance broker	SERVICE FEE

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

72325-8

Policy instance

Insurance contract or identification number	72325-8
Number of Individuals Covered	3367
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $47,846
Total amount of fees paid to insurance company	USD $38,277
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $478,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	38277
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $38,277

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	6526
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5523
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889751001

Policy instance

Insurance contract or identification number	98889751001
Number of Individuals Covered	9679
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 $892,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889831001

Policy instance

Insurance contract or identification number	98889831001
Number of Individuals Covered	55
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 $6,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	329
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	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $452,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6384
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,210,510
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

06946A

Policy instance

Insurance contract or identification number	06946A
Number of Individuals Covered	37
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
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION/REPATRIATION COV.
Welfare Benefit Premiums Paid to Carrier	USD $321,398
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

758370

Policy instance

Insurance contract or identification number	758370
Number of Individuals Covered	5080
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $89,185
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,143
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 )

Policy contract number

76046

Policy instance

Insurance contract or identification number	76046
Number of Individuals Covered	5461
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
Welfare Benefit Premiums Paid to Carrier	USD $296,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 )

Policy contract number

76047

Policy instance

Insurance contract or identification number	76047
Number of Individuals Covered	4390
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	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $535,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5737
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
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	6493
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
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889751001

Policy instance

Insurance contract or identification number	98889751001
Number of Individuals Covered	9772
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 $895,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889831001

Policy instance

Insurance contract or identification number	98889831001
Number of Individuals Covered	73
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 $9,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	343
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	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $411,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6424
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,160,080
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

758370

Policy instance

Insurance contract or identification number	758370
Number of Individuals Covered	5295
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $52,919
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,919
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 )

Policy contract number

76046

Policy instance

Insurance contract or identification number	76046
Number of Individuals Covered	5048
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
Welfare Benefit Premiums Paid to Carrier	USD $296,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SECURIAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93742 )

Policy contract number

76047

Policy instance

Insurance contract or identification number	76047
Number of Individuals Covered	4062
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	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $551,585
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

06946A

Policy instance

Insurance contract or identification number	06946A
Number of Individuals Covered	44
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
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION/REPATRIATION COV.
Welfare Benefit Premiums Paid to Carrier	USD $273,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	349
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	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $431,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5746
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
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	6257
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
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889751001

Policy instance

Insurance contract or identification number	98889751001
Number of Individuals Covered	9464
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $883,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889831001

Policy instance

Insurance contract or identification number	98889831001
Number of Individuals Covered	120
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

402854G

Policy instance

Insurance contract or identification number	402854G
Number of Individuals Covered	5083
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,387,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6485
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
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,648,809
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

06946A

Policy instance

Insurance contract or identification number	06946A
Number of Individuals Covered	50
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
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION/REPATRIATION COV.
Welfare Benefit Premiums Paid to Carrier	USD $443,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0162429

Policy instance

Insurance contract or identification number	0162429
Number of Individuals Covered	585
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $17,882
Total amount of fees paid to insurance company	USD $874
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,882
Amount paid for insurance broker fees	874
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0162428

Policy instance

Insurance contract or identification number	0162428
Number of Individuals Covered	2823
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $147,564
Total amount of fees paid to insurance company	USD $10,499
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $428,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $147,564
Amount paid for insurance broker fees	10499
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0162430

Policy instance

Insurance contract or identification number	0162430
Number of Individuals Covered	4584
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $93,039
Total amount of fees paid to insurance company	USD $6,341
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $284,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $93,039
Amount paid for insurance broker fees	6341
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0162427

Policy instance

Insurance contract or identification number	0162427
Number of Individuals Covered	585
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $28,531
Total amount of fees paid to insurance company	USD $1,185
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $63,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,531
Amount paid for insurance broker fees	1185
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY 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

06946A

Policy instance

Insurance contract or identification number	06946A
Number of Individuals Covered	71
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION/REPATRIATION COV.
Welfare Benefit Premiums Paid to Carrier	USD $466,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0162429

Policy instance

Insurance contract or identification number	0162429
Number of Individuals Covered	486
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,065
Total amount of fees paid to insurance company	USD $357
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,065
Amount paid for insurance broker fees	357
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0162428

Policy instance

Insurance contract or identification number	0162428
Number of Individuals Covered	5499
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $76,516
Total amount of fees paid to insurance company	USD $-4,420
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $394,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $267,274
Amount paid for insurance broker fees	43
Additional information about fees paid to insurance broker	MARKETING FEES
Insurance broker organization code?	3

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

Policy contract number

0162430

Policy instance

Insurance contract or identification number	0162430
Number of Individuals Covered	9035
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $55,156
Total amount of fees paid to insurance company	USD $2,426
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $216,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,156
Amount paid for insurance broker fees	2426
Additional information about fees paid to insurance broker	SUPPLEMENTALAND NON-MONETARY COMPENSATION AND MARKETING FEES
Insurance broker organization code?	3

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

Policy contract number

0162427

Policy instance

Insurance contract or identification number	0162427
Number of Individuals Covered	486
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $19,996
Total amount of fees paid to insurance company	USD $793
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $52,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,996
Amount paid for insurance broker fees	793
Additional information about fees paid to insurance broker	SUPPLEMENTAL AND NON-MONETARY COMPENSATION AND MARKETING FEES
Insurance broker organization code?	3

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

Policy contract number

402854G

Policy instance

Insurance contract or identification number	402854G
Number of Individuals Covered	5296
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $748,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6601
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,585,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	362
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $393,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5854
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	6157
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889751001

Policy instance

Insurance contract or identification number	98889751001
Number of Individuals Covered	9573
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $883,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889831001

Policy instance

Insurance contract or identification number	98889831001
Number of Individuals Covered	88
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	371
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $380,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5889
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	5718
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889751001

Policy instance

Insurance contract or identification number	98889751001
Number of Individuals Covered	9210
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $733,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98889831001

Policy instance

Insurance contract or identification number	98889831001
Number of Individuals Covered	77
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

402854G

Policy instance

Insurance contract or identification number	402854G
Number of Individuals Covered	4827
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $578,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6455
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,542,070
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

06946A

Policy instance

Insurance contract or identification number	06946A
Number of Individuals Covered	72
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION/REPATRIATION COV.
Welfare Benefit Premiums Paid to Carrier	USD $419,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0162429

Policy instance

Insurance contract or identification number	0162429
Number of Individuals Covered	442
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $19,361
Total amount of fees paid to insurance company	USD $596
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,361
Amount paid for insurance broker fees	596
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS ADMIN LLC

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

Policy contract number

0162428

Policy instance

Insurance contract or identification number	0162428
Number of Individuals Covered	2180
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $192,358
Total amount of fees paid to insurance company	USD $5,919
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $347,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $192,358
Amount paid for insurance broker fees	5919
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS ADMIN LLC

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

Policy contract number

0162430

Policy instance

Insurance contract or identification number	0162430
Number of Individuals Covered	3733
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $131,886
Total amount of fees paid to insurance company	USD $4,058
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $190,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $131,886
Amount paid for insurance broker fees	4058
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS ADMIN LLC

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

Policy contract number

0162427

Policy instance

Insurance contract or identification number	0162427
Number of Individuals Covered	455
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,682
Total amount of fees paid to insurance company	USD $883
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $51,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,682
Amount paid for insurance broker fees	883
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS ADMIN LLC

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6191
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,437,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	389
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $340,297
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

LK960218

Policy instance

Insurance contract or identification number	LK960218
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $264,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	4829
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
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9888975

Policy instance

Insurance contract or identification number	9888975
Number of Individuals Covered	8233
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $663,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9888983

Policy instance

Insurance contract or identification number	9888983
Number of Individuals Covered	55
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

402854G

Policy instance

Insurance contract or identification number	402854G
Number of Individuals Covered	4606
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $229,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5829
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
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5831
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

32620

Policy instance

Insurance contract or identification number	32620
Number of Individuals Covered	6064
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,155,361
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

LK960218

Policy instance

Insurance contract or identification number	LK960218
Number of Individuals Covered	4532
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $514,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9888983

Policy instance

Insurance contract or identification number	9888983
Number of Individuals Covered	49
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9888975

Policy instance

Insurance contract or identification number	9888975
Number of Individuals Covered	8024
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $646,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	4499
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

49045-LTC

Policy instance

Insurance contract or identification number	49045-LTC
Number of Individuals Covered	402
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $232,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5697
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	4473
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9688409

Policy instance

Insurance contract or identification number	9688409
Number of Individuals Covered	42
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,122
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9686494

Policy instance

Insurance contract or identification number	9686494
Number of Individuals Covered	7890
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $620,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9688409

Policy instance

Insurance contract or identification number	9688409
Number of Individuals Covered	56
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9686494

Policy instance

Insurance contract or identification number	9686494
Number of Individuals Covered	7704
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $603,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	4289
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5604
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT LAKES DELTA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90301 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5581
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9688409

Policy instance

Insurance contract or identification number	9688409
Number of Individuals Covered	36
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9686494

Policy instance

Insurance contract or identification number	9686494
Number of Individuals Covered	7529
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $587,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT LAKES DELTA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90301 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	3887
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9686494

Policy instance

Insurance contract or identification number	9686494
Number of Individuals Covered	7221
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $563,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT LAKES DELTA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90301 )

Policy contract number

0009541

Policy instance

Insurance contract or identification number	0009541
Number of Individuals Covered	5594
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT LAKES DELTA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90301 )

Policy contract number

0005541

Policy instance

Insurance contract or identification number	0005541
Number of Individuals Covered	3779
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9688409

Policy instance

Insurance contract or identification number	9688409
Number of Individuals Covered	61
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	UNIVERSITY OF NOTRE DAME DU LAC
Employer identification number (EIN):	350868188
NAIC Classification:	611000

Jurisdiction of Incorporation:	Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number:	902916