 |
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|
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| Plan Name | EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY |
| Employer identification number (EIN): | 450228055 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2020-01-01 | DARREN WALKER | 2021-07-08 | ||
| 502 | 2019-01-01 | DARREN WALKER | 2020-07-23 | ||
| 502 | 2017-01-01 | ||||
| 502 | 2016-01-01 | JAN RITTER | |||
| 502 | 2015-01-01 | DEAN MERTZ | |||
| 502 | 2014-01-01 | DEAN MERTZ | |||
| 502 | 2013-01-01 | DEAN MERTZ | |||
| 502 | 2012-01-01 | DEAN MERTZ | |||
| 502 | 2011-01-01 | DEAN MERTZ | |||
| 502 | 2010-01-01 | DEAN MERTZ | |||
| 502 | 2009-01-01 | DEAN MERTZ |
| Measure | Date | Value |
|---|---|---|
| 2020: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 17,399 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 0 |
| 2019: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 20,099 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 17,291 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 108 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 17,399 |
| 2017: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 19,920 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 18,947 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 65 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 19,012 |
| 2016: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 19,855 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 19,920 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 20 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 19,940 |
| 2015: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-01-01 | 20,289 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 19,738 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 117 |
| Total of all active and inactive participants | 2015-01-01 | 19,855 |
| 2014: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-01-01 | 11,608 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 20,289 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 20,289 |
| 2013: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-01-01 | 11,809 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 11,608 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 11,608 |
| 2012: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 11,765 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 11,809 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 149 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 11,958 |
| 2011: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-01-01 | 12,087 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 12,068 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 133 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 12,201 |
| 2010: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 11,979 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 11,823 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 209 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 12,032 |
| 2009: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 12,444 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 11,819 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 11,819 |
| 2020: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | Yes |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 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 |
| 2017: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 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: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 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: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE 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: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2010 form 5500 responses | ||
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 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: EV LUTHERAN GOOD SAMARITAN SOCIETY GROUP INSURANCE PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 8708092 |
| Policy instance | 5 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 12 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 ) | |
| Policy contract number | 38983 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 1843 |
| Policy instance | 3 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 203778 |
| Policy instance | 4 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 6 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | ER00030308 |
| Policy instance | 7 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 425681 |
| Policy instance | 8 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 425682 |
| Policy instance | 9 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 425683 |
| Policy instance | 10 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30077480 |
| Policy instance | 11 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 905851 |
| Policy instance | 10 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | BA5006 |
| Policy instance | 8 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 6 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 ) | |
| Policy contract number | 38983 |
| Policy instance | 2 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 203778 |
| Policy instance | 4 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 8708092 |
| Policy instance | 5 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | ER00030308 |
| Policy instance | 9 |
| SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 ) | |
| Policy contract number | HP040503 |
| Policy instance | 7 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 425681 |
| Policy instance | 11 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 1843 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 425682 |
| Policy instance | 12 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 15 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30077480 |
| Policy instance | 14 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 425683 |
| Policy instance | 13 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | ER00030308 |
| Policy instance | 17 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 18 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0154378 |
| Policy instance | 8 |
| HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 ) | |
| Policy contract number | 38983 |
| Policy instance | 4 |
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 6090206 |
| Policy instance | 5 |
| SANFORD HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95683 ) | |
| Policy contract number | HP040503 |
| Policy instance | 15 |
| NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) | |
| Policy contract number | 0001 |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | V6896 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0167150 |
| Policy instance | 9 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0117675 |
| Policy instance | 7 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 92390 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0167152 |
| Policy instance | 11 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0167153 |
| Policy instance | 12 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0167154 |
| Policy instance | 13 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 14 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | BA5006 |
| Policy instance | 16 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 1843 |
| Policy instance | 6 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0167151 |
| Policy instance | 10 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | BA5006 |
| Policy instance | 2 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 6 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0154378 |
| Policy instance | 1 |
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 6090206 |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | V6896 |
| Policy instance | 4 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 92390 |
| Policy instance | 5 |
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) | |
| Policy contract number | 3898 |
| Policy instance | 7 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 675155G |
| Policy instance | 8 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 9 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 117675 |
| Policy instance | 10 |
| NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) | |
| Policy contract number | 0001 |
| Policy instance | 11 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | BA5006 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0154378 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 117675 |
| Policy instance | 3 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 4 |
| NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) | |
| Policy contract number | 0001 |
| Policy instance | 5 |
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 6090206 |
| Policy instance | 6 |
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) | |
| Policy contract number | 28545 |
| Policy instance | 9 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 10 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 675155G |
| Policy instance | 8 |
| HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 ) | |
| Policy contract number | 3898 |
| Policy instance | 7 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) | |
| Policy contract number | EP362 |
| Policy instance | 1 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 6545246-LTC |
| Policy instance | 3 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | BN2158 |
| Policy instance | 8 |
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 6090206 |
| Policy instance | 7 |
| NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) | |
| Policy contract number | 001 |
| Policy instance | 6 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 5 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0117675 |
| Policy instance | 4 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 675155G |
| Policy instance | 2 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) | |
| Policy contract number | EP362 |
| Policy instance | 1 |
| TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 ) | |
| Policy contract number | BN2158 |
| Policy instance | 10 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 9 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0117675 |
| Policy instance | 8 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) | |
| Policy contract number | 1301 |
| Policy instance | 7 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 675155G |
| Policy instance | 6 |
| DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 ) | |
| Policy contract number | 32280-32285 |
| Policy instance | 5 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 2 |
| NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) | |
| Policy contract number | 0001 |
| Policy instance | 3 |
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 6090206 |
| Policy instance | 4 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) | |
| Policy contract number | EP362 |
| Policy instance | 1 |
| BROKERS NATIONAL LIFE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 74900 ) | |
| Policy contract number | 82286 |
| Policy instance | 10 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 9 |
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 6090206 |
| Policy instance | 4 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0117675 |
| Policy instance | 8 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) | |
| Policy contract number | 1301 |
| Policy instance | 7 |
| DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 ) | |
| Policy contract number | 32280-32285 |
| Policy instance | 5 |
| NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) | |
| Policy contract number | 0001 |
| Policy instance | 3 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 2 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 675155G |
| Policy instance | 6 |
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) | |
| Policy contract number | GTU 0030513 |
| Policy instance | 2 |
| NEBRASKA METHODIST HEALTH SYSTEM D/B/A BESTCARE EAP (National Association of Insurance Commissioners NAIC id number: 00 ) | |
| Policy contract number | 0001 |
| Policy instance | 3 |
| DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 ) | |
| Policy contract number | 32280-32285 |
| Policy instance | 4 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 675155G |
| Policy instance | 5 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) | |
| Policy contract number | 1301 |
| Policy instance | 6 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0117675 |
| Policy instance | 7 |
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |
| Policy contract number | 45246-LTC |
| Policy instance | 8 |
| BROKERS NATIONAL LIFE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 74900 ) | |
| Policy contract number | 82286 |
| Policy instance | 9 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) | |
| Policy contract number | EP362 |
| Policy instance | 1 |
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