401k Plan data: MUNSON HEALTH AND WELFARE PLAN plan

MUNSON HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	MUNSON HEALTH AND WELFARE PLAN
Plan identification number	510

MUNSON HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

MUNSON HEALTHCARE has sponsored the creation of one or more 401k plans.

Company Name: MUNSON HEALTHCARE

Employer identification number (EIN): 382640544

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Additional information about MUNSON HEALTHCARE

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs

Incorporation Date:

Company Identification Number: 719519

More information about MUNSON HEALTHCARE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MUNSON HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2022-07-01
510 2021-07-01
510 2020-07-01
510 2019-07-01
510 2018-07-01
510 2017-07-01 MARK A. HEPLER MARK A. HEPLER 2019-01-31
510 2016-07-01 MARK A. HEPLER MARK A. HEPLER 2018-01-30
510 2015-07-01 MARK A. HEPLER MARK A. HEPLER 2017-01-31
510 2014-07-01 MARK A. HEPLER MARK A. HEPLER 2016-02-01
510 2013-07-01 MARK A. HEPLER MARK A. HEPLER 2015-02-02
510 2012-07-01 MARK A. HEPLER MARK A. HEPLER 2014-01-30
510 2011-07-01 MARK A. HEPLER MARK A. HEPLER 2013-01-31

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
510	2022-07-01
510	2021-07-01
510	2020-07-01
510	2019-07-01
510	2018-07-01
510	2017-07-01	MARK A. HEPLER	MARK A. HEPLER	2019-01-31
510	2016-07-01	MARK A. HEPLER	MARK A. HEPLER	2018-01-30
510	2015-07-01	MARK A. HEPLER	MARK A. HEPLER	2017-01-31
510	2014-07-01	MARK A. HEPLER	MARK A. HEPLER	2016-02-01
510	2013-07-01	MARK A. HEPLER	MARK A. HEPLER	2015-02-02
510	2012-07-01	MARK A. HEPLER	MARK A. HEPLER	2014-01-30
510	2011-07-01	MARK A. HEPLER	MARK A. HEPLER	2013-01-31

Plan Statistics for MUNSON HEALTH AND WELFARE PLAN

401k plan membership statisitcs for MUNSON HEALTH AND WELFARE PLAN

Measure Date Value
2022: MUNSON HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 6,557
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 6,527
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 6,527
2021: MUNSON HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 6,017
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 6,557
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 6,557
2020: MUNSON HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 6,472
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 6,017
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 6,017
2019: MUNSON HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 6,196
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 6,472
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 6,472
2018: MUNSON HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 5,885
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 6,196
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 6,196
2017: MUNSON HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 7,902
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 5,885
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 5,885
2016: MUNSON HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 5,986
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 6,886
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 6,886
2015: MUNSON HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 5,411
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 5,986
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 5,986
2014: MUNSON HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 4,882
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 6,546
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 6,546
2013: MUNSON HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 4,890
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 4,882
Total of all active and inactive participants 2013-07-01 4,882
2012: MUNSON HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 4,213
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 4,245
Total of all active and inactive participants 2012-07-01 4,245
2011: MUNSON HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 4,077
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 4,207
Total of all active and inactive participants 2011-07-01 4,207

Measure	Date	Value
2022: MUNSON HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	6,557
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	6,527
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	6,527
2021: MUNSON HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	6,017
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	6,557
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	6,557
2020: MUNSON HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	6,472
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	6,017
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	6,017
2019: MUNSON HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	6,196
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	6,472
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	6,472
2018: MUNSON HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	5,885
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	6,196
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	6,196
2017: MUNSON HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	7,902
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	5,885
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	5,885
2016: MUNSON HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	5,986
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	6,886
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	6,886
2015: MUNSON HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	5,411
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	5,986
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	5,986
2014: MUNSON HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	4,882
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	6,546
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	6,546
2013: MUNSON HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	4,890
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	4,882
Total of all active and inactive participants	2013-07-01	4,882
2012: MUNSON HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	4,213
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	4,245
Total of all active and inactive participants	2012-07-01	4,245
2011: MUNSON HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	4,077
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	4,207
Total of all active and inactive participants	2011-07-01	4,207

Form 5500 Responses for MUNSON HEALTH AND WELFARE PLAN

2022: MUNSON HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: MUNSON HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: MUNSON HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: MUNSON HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MUNSON HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MUNSON HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MUNSON HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MUNSON HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MUNSON HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MUNSON HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MUNSON HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MUNSON HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	6527
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $13,735
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,774,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,735
Insurance broker organization code?	3

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

Policy contract number

30075690

Policy instance

Insurance contract or identification number	30075690
Number of Individuals Covered	5075
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,796,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001

Policy instance

Insurance contract or identification number	600001
Number of Individuals Covered	12110
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,679,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	1273
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $234,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001

Policy instance

Insurance contract or identification number	600001
Number of Individuals Covered	12286
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,067,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

30075690

Policy instance

Insurance contract or identification number	30075690
Number of Individuals Covered	5167
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,841,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	6557
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $22,453
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,587,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,453
Insurance broker organization code?	3

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	1238
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $252,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	1214
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $249,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	6017
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $4,270
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADDITIONAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,766,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,270
Insurance broker organization code?	3

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

Policy contract number

30075690

Policy instance

Insurance contract or identification number	30075690
Number of Individuals Covered	5193
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,360,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001

Policy instance

Insurance contract or identification number	600001
Number of Individuals Covered	11454
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,379,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001

Policy instance

Insurance contract or identification number	600001
Number of Individuals Covered	11800
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,607,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	6472
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $13,262
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADDITIONAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,389,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,262
Insurance broker organization code?	3

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

Policy contract number

30075690

Policy instance

Insurance contract or identification number	30075690
Number of Individuals Covered	4966
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,361,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	1223
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $246,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	1100
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $219,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	6196
Insurance policy end date	2019-06-30
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADDITIONAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,877,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001

Policy instance

Insurance contract or identification number	600001
Number of Individuals Covered	11604
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,786,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

30075690

Policy instance

Insurance contract or identification number	30075690
Number of Individuals Covered	4757
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,269,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001

Policy instance

Insurance contract or identification number	600001
Number of Individuals Covered	11117
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,064,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	5885
Insurance policy end date	2018-06-30
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADDITIONAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,697,602
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

30075690

Policy instance

Insurance contract or identification number	30075690
Number of Individuals Covered	4258
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,094,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	967
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $204,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061022

Policy instance

Insurance contract or identification number	000099061022
Number of Individuals Covered	7995
Insurance policy start date	2017-04-01
Insurance policy end date	2018-04-01
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907858

Policy instance

Insurance contract or identification number	9907858
Number of Individuals Covered	48
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907866

Policy instance

Insurance contract or identification number	9907866
Number of Individuals Covered	295
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	846
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $178,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

VDT961619

Policy instance

Insurance contract or identification number	VDT961619
Number of Individuals Covered	622
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $262,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907874

Policy instance

Insurance contract or identification number	9907874
Number of Individuals Covered	107
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907841

Policy instance

Insurance contract or identification number	9907841
Number of Individuals Covered	9
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907833

Policy instance

Insurance contract or identification number	9907833
Number of Individuals Covered	5775
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $322,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 967547

Policy instance

Insurance contract or identification number	OK 967547
Number of Individuals Covered	3191
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $31,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000042

Policy instance

Insurance contract or identification number	1000042
Number of Individuals Covered	320
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000041

Policy instance

Insurance contract or identification number	1000041
Number of Individuals Covered	535
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000036

Policy instance

Insurance contract or identification number	1000036
Number of Individuals Covered	9
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907395

Policy instance

Insurance contract or identification number	9907395
Number of Individuals Covered	11
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000035

Policy instance

Insurance contract or identification number	1000035
Number of Individuals Covered	1193
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $178,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000040

Policy instance

Insurance contract or identification number	1000040
Number of Individuals Covered	2
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000039

Policy instance

Insurance contract or identification number	1000039
Number of Individuals Covered	20
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000038

Policy instance

Insurance contract or identification number	1000038
Number of Individuals Covered	142
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000044

Policy instance

Insurance contract or identification number	1000044
Number of Individuals Covered	587
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000043

Policy instance

Insurance contract or identification number	1000043
Number of Individuals Covered	535
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000037

Policy instance

Insurance contract or identification number	1000037
Number of Individuals Covered	1
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 967564

Policy instance

Insurance contract or identification number	OK 967564
Number of Individuals Covered	8617
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $204,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061022

Policy instance

Insurance contract or identification number	000099061022
Number of Individuals Covered	5986
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK964121

Policy instance

Insurance contract or identification number	LK964121
Number of Individuals Covered	2652
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,270,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	5426
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,432,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001

Policy instance

Insurance contract or identification number	600001
Number of Individuals Covered	10776
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,078,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 967547

Policy instance

Insurance contract or identification number	OK 967547
Number of Individuals Covered	2576
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 967564

Policy instance

Insurance contract or identification number	OK 967564
Number of Individuals Covered	6827
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061022

Policy instance

Insurance contract or identification number	000099061022
Number of Individuals Covered	6546
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK964121

Policy instance

Insurance contract or identification number	LK964121
Number of Individuals Covered	2259
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $959,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965991

Policy instance

Insurance contract or identification number	FLX965991
Number of Individuals Covered	4149
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $983,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001-600013

Policy instance

Insurance contract or identification number	600001-600013
Number of Individuals Covered	8902
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,681,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907833

Policy instance

Insurance contract or identification number	9907833
Number of Individuals Covered	5866
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $373,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907841

Policy instance

Insurance contract or identification number	9907841
Number of Individuals Covered	13
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907874

Policy instance

Insurance contract or identification number	9907874
Number of Individuals Covered	118
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000041

Policy instance

Insurance contract or identification number	1000041
Number of Individuals Covered	470
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000042

Policy instance

Insurance contract or identification number	1000042
Number of Individuals Covered	297
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907858

Policy instance

Insurance contract or identification number	9907858
Number of Individuals Covered	55
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9907866

Policy instance

Insurance contract or identification number	9907866
Number of Individuals Covered	296
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	620
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $110,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

VDT961619

Policy instance

Insurance contract or identification number	VDT961619
Number of Individuals Covered	41
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 148346

Policy instance

Insurance contract or identification number	GL 148346
Number of Individuals Covered	152
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 111833

Policy instance

Insurance contract or identification number	LTD 111833
Number of Individuals Covered	2097
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,106,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	RSL INC CO

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061022

Policy instance

Insurance contract or identification number	000099061022
Number of Individuals Covered	4882
Insurance policy start date	2013-04-01
Insurance policy end date	2014-04-01
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 119014

Policy instance

Insurance contract or identification number	LTD 119014
Number of Individuals Covered	272
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $191,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 138022

Policy instance

Insurance contract or identification number	GL 138022
Number of Individuals Covered	4701
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,010,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785205

Policy instance

Insurance contract or identification number	9785205
Number of Individuals Covered	6288
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $253,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9817834

Policy instance

Insurance contract or identification number	9817834
Number of Individuals Covered	268
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9812637

Policy instance

Insurance contract or identification number	9812637
Number of Individuals Covered	54
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785908

Policy instance

Insurance contract or identification number	9785908
Number of Individuals Covered	119
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001-600013

Policy instance

Insurance contract or identification number	600001-600013
Number of Individuals Covered	8676
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,729,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785585

Policy instance

Insurance contract or identification number	9785585
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 203164

Policy instance

Insurance contract or identification number	VAR 203164
Number of Individuals Covered	2640
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $165,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	579
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $123,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	554
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $100,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 111833

Policy instance

Insurance contract or identification number	LTD 111833
Number of Individuals Covered	2097
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $821,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	RSL INC CO

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061022

Policy instance

Insurance contract or identification number	000099061022
Number of Individuals Covered	4890
Insurance policy start date	2012-04-01
Insurance policy end date	2013-04-01
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 119014

Policy instance

Insurance contract or identification number	LTD 119014
Number of Individuals Covered	272
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 138022

Policy instance

Insurance contract or identification number	GL 138022
Number of Individuals Covered	4701
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,140,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 203164

Policy instance

Insurance contract or identification number	VAR 203164
Number of Individuals Covered	2640
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $179,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785205

Policy instance

Insurance contract or identification number	9785205
Number of Individuals Covered	6265
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $252,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785908

Policy instance

Insurance contract or identification number	9785908
Number of Individuals Covered	132
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 148346

Policy instance

Insurance contract or identification number	GL 148346
Number of Individuals Covered	152
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	ASSIGNED AGENT

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9817834

Policy instance

Insurance contract or identification number	9817834
Number of Individuals Covered	246
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785585

Policy instance

Insurance contract or identification number	9785585
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001-600013

Policy instance

Insurance contract or identification number	600001-600013
Number of Individuals Covered	8348
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,453,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9812637

Policy instance

Insurance contract or identification number	9812637
Number of Individuals Covered	47
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

6090205

Policy instance

Insurance contract or identification number	6090205
Number of Individuals Covered	529
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $104,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 138022

Policy instance

Insurance contract or identification number	GL 138022
Number of Individuals Covered	4662
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $922,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001-600013

Policy instance

Insurance contract or identification number	600001-600013
Number of Individuals Covered	8335
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,028,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 111833

Policy instance

Insurance contract or identification number	LTD 111833
Number of Individuals Covered	2158
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $915,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 119014

Policy instance

Insurance contract or identification number	LTD 119014
Number of Individuals Covered	233
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $136,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061022

Policy instance

Insurance contract or identification number	000099061022
Number of Individuals Covered	4839
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 203164

Policy instance

Insurance contract or identification number	VAR 203164
Number of Individuals Covered	2717
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $148,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785205

Policy instance

Insurance contract or identification number	9785205
Number of Individuals Covered	6023
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $241,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9812637

Policy instance

Insurance contract or identification number	9812637
Number of Individuals Covered	42
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785908

Policy instance

Insurance contract or identification number	9785908
Number of Individuals Covered	118
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9817834

Policy instance

Insurance contract or identification number	9817834
Number of Individuals Covered	166
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 148346

Policy instance

Insurance contract or identification number	GL 148346
Number of Individuals Covered	125
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )

Policy contract number

600001-600013

Policy instance

Insurance contract or identification number	600001-600013
Number of Individuals Covered	7864
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 111833

Policy instance

Insurance contract or identification number	LTD 111833
Number of Individuals Covered	2063
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
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

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 119014

Policy instance

Insurance contract or identification number	LTD 119014
Number of Individuals Covered	210
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
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

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000099061022

Policy instance

Insurance contract or identification number	000099061022
Number of Individuals Covered	4776
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 138022

Policy instance

Insurance contract or identification number	GL 138022
Number of Individuals Covered	4456
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $926,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785205

Policy instance

Insurance contract or identification number	9785205
Number of Individuals Covered	5271
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $216,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9812637

Policy instance

Insurance contract or identification number	9812637
Number of Individuals Covered	30
Insurance policy start date	2011-02-01
Insurance policy end date	2011-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

9785908

Policy instance

Insurance contract or identification number	9785908
Number of Individuals Covered	82
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 203164

Policy instance

Insurance contract or identification number	VAR 203164
Number of Individuals Covered	2505
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MUNSON HEALTHCARE
Employer identification number (EIN):	382640544
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners

Jurisdiction of Incorporation:	Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number:	719519