401k Plan data: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN plan

RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

RUSH UNIVERSITY MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: RUSH UNIVERSITY MEDICAL CENTER

Employer identification number (EIN): 362174823

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 PATRICIA STEEVES O'NEIL 2020-10-14 PATRICIA STEEVES O'NEIL 2020-10-14
501 2018-01-01 PATRICIA S. O'NEIL 2019-10-15 PATRICIA S. O'NEIL 2019-10-15
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2015-01-01
501 2014-01-01 PATRICIA ONEIL PATRICIA ONEIL 2015-10-13
501 2013-01-01 PATRICIA ONEIL PATRICIA ONEIL 2014-10-28
501 2012-01-01 PATRICIA S. O'NEIL
501 2011-01-01 PATRICIA S. O'NEIL
501 2010-01-01 PATRICIA S. O'NEIL
501 2009-01-01 PATRICIA S. O'NEIL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01	PATRICIA STEEVES O'NEIL	2020-10-14	PATRICIA STEEVES O'NEIL	2020-10-14
501	2018-01-01	PATRICIA S. O'NEIL	2019-10-15	PATRICIA S. O'NEIL	2019-10-15
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2015-01-01
501	2014-01-01	PATRICIA ONEIL		PATRICIA ONEIL	2015-10-13
501	2013-01-01	PATRICIA ONEIL		PATRICIA ONEIL	2014-10-28
501	2012-01-01	PATRICIA S. O'NEIL
501	2011-01-01	PATRICIA S. O'NEIL
501	2010-01-01	PATRICIA S. O'NEIL
501	2009-01-01	PATRICIA S. O'NEIL

Plan Statistics for RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2019: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 10,809
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 11,226
Number of retired or separated participants receiving benefits 2019-01-01 499
Total of all active and inactive participants 2019-01-01 11,725
Total participants 2019-01-01 11,725
2018: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 10,696
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 10,425
Number of retired or separated participants receiving benefits 2018-01-01 384
Total of all active and inactive participants 2018-01-01 10,809
Total participants 2018-01-01 10,809
2017: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 11,597
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 10,372
Number of retired or separated participants receiving benefits 2017-01-01 324
Total of all active and inactive participants 2017-01-01 10,696
Total participants 2017-01-01 10,696
2016: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 10,009
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 11,290
Number of retired or separated participants receiving benefits 2016-01-01 307
Total of all active and inactive participants 2016-01-01 11,597
Total participants 2016-01-01 11,597
2015: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 9,556
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 9,672
Number of retired or separated participants receiving benefits 2015-01-01 337
Total of all active and inactive participants 2015-01-01 10,009
Total participants 2015-01-01 10,009
2014: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 9,281
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 9,202
Number of retired or separated participants receiving benefits 2014-01-01 354
Total of all active and inactive participants 2014-01-01 9,556
Total participants 2014-01-01 9,556
2013: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 8,956
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 8,905
Number of retired or separated participants receiving benefits 2013-01-01 376
Total of all active and inactive participants 2013-01-01 9,281
Total participants 2013-01-01 9,281
2012: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8,620
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 8,956
Total of all active and inactive participants 2012-01-01 8,956
Total participants 2012-01-01 8,956
2011: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 8,723
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 8,620
Total of all active and inactive participants 2011-01-01 8,620
Total participants 2011-01-01 8,620
2010: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 7,068
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 8,723
Total of all active and inactive participants 2010-01-01 8,723
Total participants 2010-01-01 8,723
2009: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 7,498
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7,068
Total of all active and inactive participants 2009-01-01 7,068
Total participants 2009-01-01 7,068

Measure	Date	Value
2019: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	10,809
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	11,226
Number of retired or separated participants receiving benefits	2019-01-01	499
Total of all active and inactive participants	2019-01-01	11,725
Total participants	2019-01-01	11,725
2018: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	10,696
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	10,425
Number of retired or separated participants receiving benefits	2018-01-01	384
Total of all active and inactive participants	2018-01-01	10,809
Total participants	2018-01-01	10,809
2017: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	11,597
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	10,372
Number of retired or separated participants receiving benefits	2017-01-01	324
Total of all active and inactive participants	2017-01-01	10,696
Total participants	2017-01-01	10,696
2016: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	10,009
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	11,290
Number of retired or separated participants receiving benefits	2016-01-01	307
Total of all active and inactive participants	2016-01-01	11,597
Total participants	2016-01-01	11,597
2015: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	9,556
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	9,672
Number of retired or separated participants receiving benefits	2015-01-01	337
Total of all active and inactive participants	2015-01-01	10,009
Total participants	2015-01-01	10,009
2014: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	9,281
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	9,202
Number of retired or separated participants receiving benefits	2014-01-01	354
Total of all active and inactive participants	2014-01-01	9,556
Total participants	2014-01-01	9,556
2013: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	8,956
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	8,905
Number of retired or separated participants receiving benefits	2013-01-01	376
Total of all active and inactive participants	2013-01-01	9,281
Total participants	2013-01-01	9,281
2012: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8,620
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	8,956
Total of all active and inactive participants	2012-01-01	8,956
Total participants	2012-01-01	8,956
2011: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	8,723
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	8,620
Total of all active and inactive participants	2011-01-01	8,620
Total participants	2011-01-01	8,620
2010: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	7,068
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	8,723
Total of all active and inactive participants	2010-01-01	8,723
Total participants	2010-01-01	8,723
2009: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	7,498
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7,068
Total of all active and inactive participants	2009-01-01	7,068
Total participants	2009-01-01	7,068

Form 5500 Responses for RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN

2019: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE 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: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE 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: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE 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: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE 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
2010: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: RUSH UNIVERSITY MEDICAL CENTER HEALTH AND WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

675517G-CI

Policy instance

Insurance contract or identification number	675517G-CI
Number of Individuals Covered	1884
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $107,133
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $305,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,133
Insurance broker organization code?	3

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

Policy contract number

675517G-ACC

Policy instance

Insurance contract or identification number	675517G-ACC
Number of Individuals Covered	2100
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $76,282
Other welfare benefits provided	ANTI CONCURRENT CAUSATION
Welfare Benefit Premiums Paid to Carrier	USD $259,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $76,282
Insurance broker organization code?	3

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8747382

Policy instance

Insurance contract or identification number	8747382
Number of Individuals Covered	93
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $3,390
Total amount of fees paid to insurance company	USD $600
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,997
Amount paid for insurance broker fees	66
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	762
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $4,871
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 $4,871
Insurance broker organization code?	3

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

Policy contract number

675517G-LIFE

Policy instance

Insurance contract or identification number	675517G-LIFE
Number of Individuals Covered	9570
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,430,743
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

675517G-ADD

Policy instance

Insurance contract or identification number	675517G-ADD
Number of Individuals Covered	9570
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $185,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

AE467159

Policy instance

Insurance contract or identification number	AE467159
Number of Individuals Covered	253
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Welfare Benefit Premiums Paid to Carrier	USD $498,492
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

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	8074
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,815,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

20313

Policy instance

Insurance contract or identification number	20313
Number of Individuals Covered	8791
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,293,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 0207218-00

Policy instance

Insurance contract or identification number	GTU 0207218-00
Number of Individuals Covered	8029
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT FOR BUSINESS TRAVEL
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: 12516 )

Policy contract number

12157623

Policy instance

Insurance contract or identification number	12157623
Number of Individuals Covered	7902
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

678225G-HI

Policy instance

Insurance contract or identification number	678225G-HI
Number of Individuals Covered	1535
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $91,349
Other welfare benefits provided	HI
Welfare Benefit Premiums Paid to Carrier	USD $339,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $91,349
Insurance broker organization code?	3

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

Policy contract number

678225G-HI

Policy instance

Insurance contract or identification number	678225G-HI
Number of Individuals Covered	1513
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $246,734
Total amount of fees paid to insurance company	USD $70,461
Other welfare benefits provided	HI
Welfare Benefit Premiums Paid to Carrier	USD $493,467
Amount paid for insurance broker fees	39774
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $246,734

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623

Policy instance

Insurance contract or identification number	12157623
Number of Individuals Covered	7582
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,391
Vision Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $8,391
Insurance broker organization code?	3

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

Policy contract number

675517G-LIFE

Policy instance

Insurance contract or identification number	675517G-LIFE
Number of Individuals Covered	9123
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,963,581

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

20313

Policy instance

Insurance contract or identification number	20313
Dental Insurance Welfare Benefit	Yes

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8747382

Policy instance

Insurance contract or identification number	8747382
Number of Individuals Covered	138
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $5,986
Total amount of fees paid to insurance company	USD $2,519
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,189
Commission paid to Insurance Broker	USD $4,278
Amount paid for insurance broker fees	212
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	727
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $4,318
Long Term Disability Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $4,318
Insurance broker organization code?	3

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

Policy contract number

675517G-CI

Policy instance

Insurance contract or identification number	675517G-CI
Number of Individuals Covered	1801
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $310,916
Total amount of fees paid to insurance company	USD $43,412
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $444,165
Amount paid for insurance broker fees	15685
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $310,916

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

Policy contract number

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	7874
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $669,490

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0100409

Policy instance

Insurance contract or identification number	0100409
Number of Individuals Covered	59
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,277

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

Policy contract number

675517G-ADD

Policy instance

Insurance contract or identification number	675517G-ADD
Number of Individuals Covered	9123
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $254,000

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

Policy contract number

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	8916
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,229,456

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

20313

Policy instance

Insurance contract or identification number	20313
Number of Individuals Covered	8414
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,189,101

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 0207218-00

Policy instance

Insurance contract or identification number	GTU 0207218-00
Number of Individuals Covered	8200
Insurance policy start date	2017-11-01
Insurance policy end date	2018-11-01
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT FOR BUSINESS TRAVEL
Insurance broker organization code?	3

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

Policy contract number

675517G-ACC

Policy instance

Insurance contract or identification number	675517G-ACC
Number of Individuals Covered	2130
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $229,148
Total amount of fees paid to insurance company	USD $37,133
Other welfare benefits provided	ANTI CONCURRENT CAUSATION
Welfare Benefit Premiums Paid to Carrier	USD $381,914
Amount paid for insurance broker fees	13392
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $229,148

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 0207218-00

Policy instance

Insurance contract or identification number	GTU 0207218-00
Number of Individuals Covered	8029
Insurance policy start date	2016-11-01
Insurance policy end date	2017-11-01
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT FOR BUSINESS TRAVEL

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623

Policy instance

Insurance contract or identification number	12157623
Number of Individuals Covered	5915
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,348
Vision Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $2,348
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8638484

Policy instance

Insurance contract or identification number	8638484
Number of Individuals Covered	184
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $7,277
Total amount of fees paid to insurance company	USD $3,468
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,129
Commission paid to Insurance Broker	USD $5,517
Amount paid for insurance broker fees	166
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	WALT SZADZINSKI & ASSOC LTD

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

Policy contract number

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	7874
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,568,383

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

Policy contract number

675517G

Policy instance

Insurance contract or identification number	675517G
Number of Individuals Covered	8840
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,208,049

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

Policy contract number

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	8873
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,523,835

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

20313

Policy instance

Insurance contract or identification number	20313
Number of Individuals Covered	851
Insurance policy start date	2017-01-01
Insurance policy end date	2018-03-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,048

SIERRA HEALTH & LIFE (National Association of Insurance Commissioners NAIC id number: 71420 )

Policy contract number

H2001

Policy instance

Insurance contract or identification number	H2001
Number of Individuals Covered	291
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $15,237
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $865,409
Commission paid to Insurance Broker	USD $15,237
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC.

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

20313

Policy instance

Insurance contract or identification number	20313
Number of Individuals Covered	8275
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,349,185

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	704
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $4,604
Long Term Disability Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $4,604
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	657
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $4,674
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 $4,674
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

2080

Policy instance

Insurance contract or identification number	2080
Number of Individuals Covered	5631
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,080,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8638484

Policy instance

Insurance contract or identification number	8638484
Number of Individuals Covered	189
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $7,903
Total amount of fees paid to insurance company	USD $4,719
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $243
Additional information about fees paid to insurance broker	FEES
Amount paid for insurance broker fees	325
Insurance broker name	PETER H HOOPIS

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

Policy contract number

ETB-105478

Policy instance

Insurance contract or identification number	ETB-105478
Number of Individuals Covered	5200
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT FOR BUSINESS TRAVEL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	337
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $17,573
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $831,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,573
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

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

Policy contract number

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	8043
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,851
Total amount of fees paid to insurance company	USD $4,775
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,845,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,851
Amount paid for insurance broker fees	4775
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

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

Policy contract number

675517G

Policy instance

Insurance contract or identification number	675517G
Number of Individuals Covered	7361
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,897
Total amount of fees paid to insurance company	USD $3,789
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,208,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,897
Amount paid for insurance broker fees	3789
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00379461

Policy instance

Insurance contract or identification number	00379461
Number of Individuals Covered	1706
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $20
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $696,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC.

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

Policy contract number

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	8001
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,080
Total amount of fees paid to insurance company	USD $4,186
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,253,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,080
Amount paid for insurance broker fees	4186
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623

Policy instance

Insurance contract or identification number	12157623
Number of Individuals Covered	6324
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,125
Total amount of fees paid to insurance company	USD $35
Vision 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 $8,125
Amount paid for insurance broker fees	35
Additional information about fees paid to insurance broker	OUTSTANDING COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623

Policy instance

Insurance contract or identification number	12157623
Number of Individuals Covered	6023
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,393
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
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

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

Policy contract number

ETB-105478

Policy instance

Insurance contract or identification number	ETB-105478
Number of Individuals Covered	4800
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	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 FOR BUSINESS TRAVEL
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

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

Policy contract number

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	7216
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $43,637
Total amount of fees paid to insurance company	USD $5,632
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 $1,090,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,637
Amount paid for insurance broker fees	5632
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

048-6974-00

Policy instance

Insurance contract or identification number	048-6974-00
Number of Individuals Covered	699
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $3,631
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	VOL LIFE VOL DEP LIFE
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 $47,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,631
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCE

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

Policy contract number

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	15538
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $49,782
Total amount of fees paid to insurance company	USD $7,801
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 $1,244,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,782
Amount paid for insurance broker fees	7801
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00379461

Policy instance

Insurance contract or identification number	00379461
Number of Individuals Covered	5861
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $77,115
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
Welfare Benefit Premiums Paid to Carrier	USD $3,967,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $77,115
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC.

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	354
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,725
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 $825,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,725
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	659
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,617
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,617
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8638484

Policy instance

Insurance contract or identification number	8638484
Number of Individuals Covered	166
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $7,380
Total amount of fees paid to insurance company	USD $3,878
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 $37,807
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	3376
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	PEARRE DAVID

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

Policy contract number

675517G

Policy instance

Insurance contract or identification number	675517G
Number of Individuals Covered	6615
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $30,898
Total amount of fees paid to insurance company	USD $5,317
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 $989,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,898
Amount paid for insurance broker fees	8317
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

2080

Policy instance

Insurance contract or identification number	2080
Number of Individuals Covered	674
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $10,042
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
Welfare Benefit Premiums Paid to Carrier	USD $201,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,042
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

048-6974-00

Policy instance

Insurance contract or identification number	048-6974-00
Number of Individuals Covered	515
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $3,703
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	VOL LIFE VOL DEP LIFE
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 $44,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,703
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCE

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623-0003

Policy instance

Insurance contract or identification number	12157623-0003
Number of Individuals Covered	3338
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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

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

Policy contract number

ETB-105478

Policy instance

Insurance contract or identification number	ETB-105478
Number of Individuals Covered	4500
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,730
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 FOR BUSINESS TRAVEL
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 $23,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,730
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH & BENEFITS

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

Policy contract number

675517G

Policy instance

Insurance contract or identification number	675517G
Number of Individuals Covered	6731
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $33,169
Total amount of fees paid to insurance company	USD $5,793
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 $1,059,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,169
Amount paid for insurance broker fees	5793
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623-0016

Policy instance

Insurance contract or identification number	12157623-0016
Number of Individuals Covered	8
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00379461

Policy instance

Insurance contract or identification number	00379461
Number of Individuals Covered	5709
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $80,542
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
Welfare Benefit Premiums Paid to Carrier	USD $3,221,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,542
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC.

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	376
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $19,805
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 $948,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,805
Insurance broker organization code?	3
Insurance broker name	UNITED HEALTHCARE INSURANCE CO.

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

Policy contract number

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	16545
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $62,197
Total amount of fees paid to insurance company	USD $6,441
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 $1,554,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,197
Amount paid for insurance broker fees	6441
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	640
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $4,609
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,609
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8638484

Policy instance

Insurance contract or identification number	8638484
Number of Individuals Covered	169
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $8,126
Total amount of fees paid to insurance company	USD $5,790
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 $35,779
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	4243
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	PEARRE DAVID

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

2080

Policy instance

Insurance contract or identification number	2080
Number of Individuals Covered	667
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $8,791
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
Welfare Benefit Premiums Paid to Carrier	USD $192,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,791
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623-0011

Policy instance

Insurance contract or identification number	12157623-0011
Number of Individuals Covered	857
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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

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

Policy contract number

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	7271
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $44,905
Total amount of fees paid to insurance company	USD $6,517
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 $1,122,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,905
Amount paid for insurance broker fees	6517
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

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

Policy contract number

ETB-105478

Policy instance

Insurance contract or identification number	ETB-105478
Number of Individuals Covered	4500
Insurance policy start date	2012-11-01
Insurance policy end date	2012-10-31
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT FOR BUSINESS TRAVEL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

048-6974-00

Policy instance

Insurance contract or identification number	048-6974-00
Number of Individuals Covered	689
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,748
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $43,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,748
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCE

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

Policy contract number

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	6866
Insurance policy start date	2012-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $42,341
Total amount of fees paid to insurance company	USD $3,745
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,196,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,341
Amount paid for insurance broker fees	3745
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00379461

Policy instance

Insurance contract or identification number	00379461
Number of Individuals Covered	5655
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $81,719
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,268,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,719
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC.

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

Policy contract number

675517G

Policy instance

Insurance contract or identification number	675517G
Number of Individuals Covered	6237
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $33,855
Total amount of fees paid to insurance company	USD $12,500
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,063,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,855
Amount paid for insurance broker fees	12500
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

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

Policy contract number

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	15069
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $43,622
Total amount of fees paid to insurance company	USD $2,505
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,182,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,622
Amount paid for insurance broker fees	2505
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	392
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Other welfare benefits provided	RETIREE HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $70,374
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

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	640
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $4,645
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 $4,645
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8638484

Policy instance

Insurance contract or identification number	8638484
Number of Individuals Covered	133
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $7,667
Total amount of fees paid to insurance company	USD $4,057
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,125
Amount paid for insurance broker fees	1071
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	PETER H HOOPIS

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

2080

Policy instance

Insurance contract or identification number	2080
Number of Individuals Covered	651
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $10,098
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $186,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,098
Insurance broker organization code?	3
Insurance broker name	RX FINANCIAL RESOURCES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623-0003

Policy instance

Insurance contract or identification number	12157623-0003
Number of Individuals Covered	5063
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,203
Vision 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 $7,203
Insurance broker organization code?	3
Insurance broker name	WEINER INSURANCE, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	640
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $4,645
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

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

Policy contract number

0119364

Policy instance

Insurance contract or identification number	0119364
Number of Individuals Covered	7475
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-30
Total amount of commissions paid to insurance broker	USD $39,896
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,261,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

2080

Policy instance

Insurance contract or identification number	2080
Number of Individuals Covered	664
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $9,518
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $190,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8638481

Policy instance

Insurance contract or identification number	8638481
Number of Individuals Covered	134
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $7,601
Total amount of fees paid to insurance company	USD $2,840
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	411
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	RETIREE HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $886,701
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

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	6154
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-30
Total amount of commissions paid to insurance broker	USD $45,305
Total amount of fees paid to insurance company	USD $2,508
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,040,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00379461

Policy instance

Insurance contract or identification number	00379461
Number of Individuals Covered	5476
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $79,805
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,192,200
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

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	6896
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-30
Total amount of commissions paid to insurance broker	USD $65,913
Total amount of fees paid to insurance company	USD $3,742
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,510,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

048-6974-00

Policy instance

Insurance contract or identification number	048-6974-00
Number of Individuals Covered	696
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $2,906
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $41,277
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: 12516 )

Policy contract number

12157623-0003

Policy instance

Insurance contract or identification number	12157623-0003
Number of Individuals Covered	3261
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-30
Vision Insurance Welfare Benefit	Yes
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

ETB-105478

Policy instance

Insurance contract or identification number	ETB-105478
Number of Individuals Covered	3500
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT FOR BUSINESS TRAVEL
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

0119365

Policy instance

Insurance contract or identification number	0119365
Number of Individuals Covered	107
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-30
Total amount of commissions paid to insurance broker	USD $185
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,812
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: 12516 )

Policy contract number

12157623-0011

Policy instance

Insurance contract or identification number	12157623-0011
Number of Individuals Covered	343
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )

Policy contract number

12157623

Policy instance

Insurance contract or identification number	12157623
Number of Individuals Covered	4646
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,986
Vision Insurance Welfare Benefit	Yes

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

048-6974-00

Policy instance

Insurance contract or identification number	048-6974-00
Number of Individuals Covered	681
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $3,102
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL LIFE VOL DEP LIFE
Welfare Benefit Premiums Paid to Carrier	USD $43,964

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

Policy contract number

675517G-LTD

Policy instance

Insurance contract or identification number	675517G-LTD
Number of Individuals Covered	7164
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $65,465
Total amount of fees paid to insurance company	USD $12,257
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,771,348

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00379461

Policy instance

Insurance contract or identification number	00379461
Number of Individuals Covered	5657
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $74,763
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,990,537

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

Policy contract number

675517G-WD

Policy instance

Insurance contract or identification number	675517G-WD
Number of Individuals Covered	6231
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $43,904
Total amount of fees paid to insurance company	USD $10,243
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,188,962

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

Policy contract number

ETB-105478

Policy instance

Insurance contract or identification number	ETB-105478
Number of Individuals Covered	3500
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $3,171
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT FOR BUSINESS TRAVEL
Welfare Benefit Premiums Paid to Carrier	USD $15,854

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

Policy contract number

0119364

Policy instance

Insurance contract or identification number	0119364
Number of Individuals Covered	9077
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $40,080
Total amount of fees paid to insurance company	USD $1,227
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	436
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Other welfare benefits provided	RETIREE HEALTH
Welfare Benefit Premiums Paid to Carrier	USD $784,498

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

642335

Policy instance

Insurance contract or identification number	642335
Number of Individuals Covered	640
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $4,606
Long Term Disability Insurance Welfare Benefit	Yes

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

8638481

Policy instance

Insurance contract or identification number	8638481
Number of Individuals Covered	131
Insurance policy start date	2010-07-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $8,529
Total amount of fees paid to insurance company	USD $3,402
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,379

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

2080

Policy instance

Insurance contract or identification number	2080
Number of Individuals Covered	675
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $9,267
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $185,349

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

Policy contract number

0119365

Policy instance

Insurance contract or identification number	0119365
Number of Individuals Covered	119
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $198
Total amount of fees paid to insurance company	USD $7
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,568

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Company Name:	RUSH UNIVERSITY MEDICAL CENTER
Employer identification number (EIN):	362174823
NAIC Classification:	622000
NAIC Description:	Hospitals