401k Plan data: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN plan

EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

CHILDRENS HEALTH SYSTEM, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHILDRENS HEALTH SYSTEM, INC.

Employer identification number (EIN): 541278830

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about CHILDRENS HEALTH SYSTEM, INC.

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1984-06-28

Company Identification Number: 0258148

Legal Registered Office Address: 601 CHILDREN'S LANE
601 CHILDRENS LN
NORFOLK
United States of America (USA)
23507

More information about CHILDRENS HEALTH SYSTEM, INC.

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 KATHRYN J ABSHIRE 2023-09-26
501 2021-01-01 KATHRYN J ABSHIRE 2022-10-17
501 2020-01-01 PAUL J. MORLOCK 2021-10-14
501 2019-01-01 PAUL J MORLOCK 2020-10-14
501 2018-01-01 PAUL J. MORLOCK 2019-10-15
501 2017-01-01
501 2016-01-01 PAUL MORLOCK
501 2015-07-01
501 2014-07-01
501 2013-07-01
501 2012-07-01 DAVID BOWERS
501 2011-07-01 DAVID BOWERS
501 2009-01-01 DAVID BOWERS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	KATHRYN J ABSHIRE	2023-09-26
501	2021-01-01	KATHRYN J ABSHIRE	2022-10-17
501	2020-01-01	PAUL J. MORLOCK	2021-10-14
501	2019-01-01	PAUL J MORLOCK	2020-10-14
501	2018-01-01	PAUL J. MORLOCK	2019-10-15
501	2017-01-01
501	2016-01-01	PAUL MORLOCK
501	2015-07-01
501	2014-07-01
501	2013-07-01
501	2012-07-01	DAVID BOWERS
501	2011-07-01	DAVID BOWERS
501	2009-01-01	DAVID BOWERS

Plan Statistics for EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2022: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 3,155
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 3,390
Number of retired or separated participants receiving benefits 2022-01-01 16
Number of other retired or separated participants entitled to future benefits 2022-01-01 75
Total of all active and inactive participants 2022-01-01 3,481
Total participants 2022-01-01 0
2021: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 3,221
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 3,098
Number of retired or separated participants receiving benefits 2021-01-01 16
Number of other retired or separated participants entitled to future benefits 2021-01-01 41
Total of all active and inactive participants 2021-01-01 3,155
Total participants 2021-01-01 0
2020: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 3,168
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 3,177
Number of retired or separated participants receiving benefits 2020-01-01 16
Number of other retired or separated participants entitled to future benefits 2020-01-01 28
Total of all active and inactive participants 2020-01-01 3,221
Total participants 2020-01-01 3,221
2019: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 3,169
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 3,108
Number of retired or separated participants receiving benefits 2019-01-01 13
Number of other retired or separated participants entitled to future benefits 2019-01-01 47
Total of all active and inactive participants 2019-01-01 3,168
Total participants 2019-01-01 3,168
2018: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 3,035
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 3,111
Number of retired or separated participants receiving benefits 2018-01-01 12
Number of other retired or separated participants entitled to future benefits 2018-01-01 46
Total of all active and inactive participants 2018-01-01 3,169
Total participants 2018-01-01 3,169
2017: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,892
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2,983
Number of retired or separated participants receiving benefits 2017-01-01 11
Number of other retired or separated participants entitled to future benefits 2017-01-01 41
Total of all active and inactive participants 2017-01-01 3,035
Total participants 2017-01-01 3,035
2016: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 2,744
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2,847
Number of retired or separated participants receiving benefits 2016-01-01 16
Number of other retired or separated participants entitled to future benefits 2016-01-01 29
Total of all active and inactive participants 2016-01-01 2,892
Total participants 2016-01-01 2,892
2015: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 2,645
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 2,725
Number of retired or separated participants receiving benefits 2015-07-01 11
Number of other retired or separated participants entitled to future benefits 2015-07-01 8
Total of all active and inactive participants 2015-07-01 2,744
Total participants 2015-07-01 2,744
2014: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 2,801
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 2,622
Number of retired or separated participants receiving benefits 2014-07-01 13
Number of other retired or separated participants entitled to future benefits 2014-07-01 10
Total of all active and inactive participants 2014-07-01 2,645
Total participants 2014-07-01 2,645
2013: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 2,461
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 2,777
Number of retired or separated participants receiving benefits 2013-07-01 11
Number of other retired or separated participants entitled to future benefits 2013-07-01 13
Total of all active and inactive participants 2013-07-01 2,801
Total participants 2013-07-01 2,801
2012: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 2,016
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 2,437
Number of retired or separated participants receiving benefits 2012-07-01 15
Number of other retired or separated participants entitled to future benefits 2012-07-01 9
Total of all active and inactive participants 2012-07-01 2,461
Total participants 2012-07-01 2,461
2011: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 2,022
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 1,984
Number of retired or separated participants receiving benefits 2011-07-01 11
Number of other retired or separated participants entitled to future benefits 2011-07-01 21
Total of all active and inactive participants 2011-07-01 2,016
Total participants 2011-07-01 2,016
2009: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,866
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,893
Number of retired or separated participants receiving benefits 2009-01-01 30
Total of all active and inactive participants 2009-01-01 1,923
Total participants 2009-01-01 1,923

Measure	Date	Value
2022: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	3,155
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3,390
Number of retired or separated participants receiving benefits	2022-01-01	16
Number of other retired or separated participants entitled to future benefits	2022-01-01	75
Total of all active and inactive participants	2022-01-01	3,481
Total participants	2022-01-01	0
2021: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	3,221
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	3,098
Number of retired or separated participants receiving benefits	2021-01-01	16
Number of other retired or separated participants entitled to future benefits	2021-01-01	41
Total of all active and inactive participants	2021-01-01	3,155
Total participants	2021-01-01	0
2020: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	3,168
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	3,177
Number of retired or separated participants receiving benefits	2020-01-01	16
Number of other retired or separated participants entitled to future benefits	2020-01-01	28
Total of all active and inactive participants	2020-01-01	3,221
Total participants	2020-01-01	3,221
2019: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	3,169
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	3,108
Number of retired or separated participants receiving benefits	2019-01-01	13
Number of other retired or separated participants entitled to future benefits	2019-01-01	47
Total of all active and inactive participants	2019-01-01	3,168
Total participants	2019-01-01	3,168
2018: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3,035
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	3,111
Number of retired or separated participants receiving benefits	2018-01-01	12
Number of other retired or separated participants entitled to future benefits	2018-01-01	46
Total of all active and inactive participants	2018-01-01	3,169
Total participants	2018-01-01	3,169
2017: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,892
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2,983
Number of retired or separated participants receiving benefits	2017-01-01	11
Number of other retired or separated participants entitled to future benefits	2017-01-01	41
Total of all active and inactive participants	2017-01-01	3,035
Total participants	2017-01-01	3,035
2016: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	2,744
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2,847
Number of retired or separated participants receiving benefits	2016-01-01	16
Number of other retired or separated participants entitled to future benefits	2016-01-01	29
Total of all active and inactive participants	2016-01-01	2,892
Total participants	2016-01-01	2,892
2015: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	2,645
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	2,725
Number of retired or separated participants receiving benefits	2015-07-01	11
Number of other retired or separated participants entitled to future benefits	2015-07-01	8
Total of all active and inactive participants	2015-07-01	2,744
Total participants	2015-07-01	2,744
2014: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	2,801
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	2,622
Number of retired or separated participants receiving benefits	2014-07-01	13
Number of other retired or separated participants entitled to future benefits	2014-07-01	10
Total of all active and inactive participants	2014-07-01	2,645
Total participants	2014-07-01	2,645
2013: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	2,461
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	2,777
Number of retired or separated participants receiving benefits	2013-07-01	11
Number of other retired or separated participants entitled to future benefits	2013-07-01	13
Total of all active and inactive participants	2013-07-01	2,801
Total participants	2013-07-01	2,801
2012: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	2,016
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	2,437
Number of retired or separated participants receiving benefits	2012-07-01	15
Number of other retired or separated participants entitled to future benefits	2012-07-01	9
Total of all active and inactive participants	2012-07-01	2,461
Total participants	2012-07-01	2,461
2011: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	2,022
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	1,984
Number of retired or separated participants receiving benefits	2011-07-01	11
Number of other retired or separated participants entitled to future benefits	2011-07-01	21
Total of all active and inactive participants	2011-07-01	2,016
Total participants	2011-07-01	2,016
2009: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,866
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,893
Number of retired or separated participants receiving benefits	2009-01-01	30
Total of all active and inactive participants	2009-01-01	1,923
Total participants	2009-01-01	1,923

Form 5500 Responses for EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN

2022: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: EMPLOYEE HEALTH AND WELFARE BENEFITS 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: EMPLOYEE HEALTH AND WELFARE BENEFITS 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: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	Yes
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: EMPLOYEE HEALTH AND WELFARE BENEFITS 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
2009: EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	1539
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $405,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	2869
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $807,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	133
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	3804
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,782
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $277,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,782
Insurance broker organization code?	3

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	643
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	LEGAL & IDENTITY THEFT PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $137,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	652
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $85,336
Total amount of fees paid to insurance company	USD $3,031
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $757,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,139
Amount paid for insurance broker fees	327
Additional information about fees paid to insurance broker	BONUSES, ETC
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	22
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,949
Total amount of fees paid to insurance company	USD $102
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $34,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $786
Amount paid for insurance broker fees	21
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	3217
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $203,154
Total amount of fees paid to insurance company	USD $110,810
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,902,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $203,154
Amount paid for insurance broker fees	32038
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	3217
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,484
Total amount of fees paid to insurance company	USD $3,974
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $106,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,484
Amount paid for insurance broker fees	1034
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	2772
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $789,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	106
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	1330
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $378,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	600
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	LEGAL & IDENTITY THEFT PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $163,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	762
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $89,783
Total amount of fees paid to insurance company	USD $4,638
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $827,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,237
Amount paid for insurance broker fees	508
Additional information about fees paid to insurance broker	BONUSES, ETC
Insurance broker organization code?	3

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	3126
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $179,411
Total amount of fees paid to insurance company	USD $99,714
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,563,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $179,411
Amount paid for insurance broker fees	32597
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	5063
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,891
Total amount of fees paid to insurance company	USD $4,007
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $98,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,891
Amount paid for insurance broker fees	1182
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	3501
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,552
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,723,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,552
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	22
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,926
Total amount of fees paid to insurance company	USD $61
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $32,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $953
Amount paid for insurance broker fees	13
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	3202
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $139,536
Total amount of fees paid to insurance company	USD $139,113
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,173,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $139,536
Amount paid for insurance broker fees	64835
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	95
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	1328
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $368,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	629
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	LEGAL & IDENTITY THEFT PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $152,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	810
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $106,557
Total amount of fees paid to insurance company	USD $7,077
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $846,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,907
Amount paid for insurance broker fees	1595
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	21
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,498
Total amount of fees paid to insurance company	USD $63
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $30,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $866
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	3177
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,653
Total amount of fees paid to insurance company	USD $4,308
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $109,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,653
Amount paid for insurance broker fees	1016
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	3529
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,703
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $274,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,703
Insurance broker organization code?	3

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	2872
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $794,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	2990
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,699
Total amount of fees paid to insurance company	USD $2,699
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $81,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,699
Amount paid for insurance broker fees	893
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	20
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,329
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $31,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $874
Insurance broker organization code?	3

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	3042
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $145,327
Total amount of fees paid to insurance company	USD $66,284
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,896,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $145,327
Amount paid for insurance broker fees	25879
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	825
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $104,702
Total amount of fees paid to insurance company	USD $6,892
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $805,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,440
Amount paid for insurance broker fees	1886
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	535
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	LEGAL & IDENTITY THEFT PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $134,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

000002349

Policy instance

Insurance contract or identification number	000002349
Number of Individuals Covered	2062
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	1103
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $313,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	87
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	2940
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $801,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	3350
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,963
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $259,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,963
Insurance broker organization code?	3

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	3094
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $784,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	1752
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,655
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $253,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,655
Insurance broker organization code?	3

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	2980
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,429
Total amount of fees paid to insurance company	USD $2,447
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $77,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,429
Amount paid for insurance broker fees	1090
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	3045
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $129,394
Total amount of fees paid to insurance company	USD $94,260
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,848,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $129,394
Amount paid for insurance broker fees	38167
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	23
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,612
Total amount of fees paid to insurance company	USD $134
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $35,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $818
Amount paid for insurance broker fees	38
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	838
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $109,835
Total amount of fees paid to insurance company	USD $5,512
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $776,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,497
Amount paid for insurance broker fees	1142
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	637
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $118,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

000002349

Policy instance

Insurance contract or identification number	000002349
Number of Individuals Covered	2118
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	96
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	1006
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $268,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	830
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $98,146
Total amount of fees paid to insurance company	USD $2,412
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $707,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,860
Amount paid for insurance broker fees	693
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 1000 EACH

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	25
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,770
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $37,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,170
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 100 EACH

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	2983
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $156,739
Total amount of fees paid to insurance company	USD $92,735
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,385,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	61562
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $156,739
Insurance broker name	CHILD HEALTH CORP OF AMERICA

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	2940
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,383
Total amount of fees paid to insurance company	USD $3,550
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $89,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,383
Amount paid for insurance broker fees	1506
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	1651
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $12,854
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $238,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,854
Insurance broker organization code?	3
Insurance broker name	CHILD HEALTH COPORATION OF AMERICA

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	546
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $129,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

000002349

Policy instance

Insurance contract or identification number	000002349
Number of Individuals Covered	1775
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	930
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $254,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	95
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	3074
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $794,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	2613
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $32,354
Total amount of fees paid to insurance company	USD $26,423
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $501,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,354
Insurance broker organization code?	3
Amount paid for insurance broker fees	26423
Additional information about fees paid to insurance broker	FEES
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	23
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,152
Total amount of fees paid to insurance company	USD $26
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $15,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $442
Amount paid for insurance broker fees	9
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 100 EACH

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	748
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $33,209
Total amount of fees paid to insurance company	USD $3,749
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $292,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,616
Amount paid for insurance broker fees	1438
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 1000 EACH

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	416
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $42,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

000002349

Policy instance

Insurance contract or identification number	000002349
Number of Individuals Covered	1674
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,102
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,102
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING/RICHMOND

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	415
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	59
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	1583
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $28,314
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $373,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,314
Insurance broker organization code?	3
Insurance broker name	AON HEWITT

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	2613
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,603
Total amount of fees paid to insurance company	USD $1,717
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $37,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,603
Insurance broker organization code?	3
Amount paid for insurance broker fees	1717
Additional information about fees paid to insurance broker	FEES
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	1395
Insurance policy start date	2015-07-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,138
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,138
Insurance broker organization code?	3
Insurance broker name	CHILD HEALTH COPORATION OF AMERICA

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	1551
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $51,480
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $731,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,480
Insurance broker organization code?	3
Insurance broker name	GARY POWERS

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	2691
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $2,126
Total amount of fees paid to insurance company	USD $5,503
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $59,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,126
Amount paid for insurance broker fees	3636
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	2671
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $81,350
Total amount of fees paid to insurance company	USD $86,284
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,208,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,350
Amount paid for insurance broker fees	43911
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	405
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 $90,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0718769

Policy instance

Insurance contract or identification number	0718769
Number of Individuals Covered	1341
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $9,988
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $216,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,988
Insurance broker organization code?	3
Insurance broker name	CHILD HEALTH CORP OF AMERICA

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	776
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $73,402
Total amount of fees paid to insurance company	USD $4,004
Welfare Benefit Premiums Paid to Carrier	USD $578,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,876
Amount paid for insurance broker fees	1513
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 1000 EACH

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

000002349

Policy instance

Insurance contract or identification number	000002349
Number of Individuals Covered	1553
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $11,294
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,294
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	362
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 $174,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	57
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 $27,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ADD-S07086

Policy instance

Insurance contract or identification number	ADD-S07086
Number of Individuals Covered	2785
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,670
Total amount of fees paid to insurance company	USD $6,763
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $62,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,670
Amount paid for insurance broker fees	3636
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	68
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 $31,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	1642
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $49,020
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $745,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,020
Insurance broker organization code?	3
Insurance broker name	GARY POWERS/CHRIS COVERT

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	379
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 $168,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

000002349

Policy instance

Insurance contract or identification number	000002349
Number of Individuals Covered	1544
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $10,571
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,571
Insurance broker name	AON CONSULTING

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	389
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 $90,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	814
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $89,722
Total amount of fees paid to insurance company	USD $1,421
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $703,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,133
Amount paid for insurance broker fees	1022
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 1000 EACH

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	25
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,559
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $31,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $579
Insurance broker organization code?	3
Insurance broker name	DAVID N. MORGAN

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	2781
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $72,636
Total amount of fees paid to insurance company	USD $93,682
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,070,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $72,636
Amount paid for insurance broker fees	43911
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MARSH & MCLENNAN AGENCY LLC

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

Policy contract number

718769

Policy instance

Insurance contract or identification number	718769
Number of Individuals Covered	1366
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $9,912
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,912
Insurance broker organization code?	3
Insurance broker name	CHILD HEALTH CORP. OF AMERICA

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	1611
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $46,680
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $711,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,680
Insurance broker organization code?	3
Insurance broker name	GARY POWERS/CHRIS COVERT

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

Policy contract number

ADD-S07071

Policy instance

Insurance contract or identification number	ADD-S07071
Number of Individuals Covered	2648
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,537
Total amount of fees paid to insurance company	USD $2,614
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $65,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,537
Insurance broker organization code?	3
Amount paid for insurance broker fees	2614
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker name	ALEXANDER BENEFITS CONSULTING, LLC

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

Policy contract number

674724G

Policy instance

Insurance contract or identification number	674724G
Number of Individuals Covered	2676
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $74,921
Total amount of fees paid to insurance company	USD $43,413
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,089,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $74,921
Insurance broker organization code?	3
Amount paid for insurance broker fees	43413
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker name	ALEXANDER BENEFITS CONSULTING LLC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

AU172

Policy instance

Insurance contract or identification number	AU172
Number of Individuals Covered	830
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $100,591
Total amount of fees paid to insurance company	USD $4,120
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $701,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,771
Amount paid for insurance broker fees	1487
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 1000 EACH

LEGAL RESOURCES (National Association of Insurance Commissioners NAIC id number: 48402 )

Policy contract number

Policy instance

Number of Individuals Covered	362
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 $72,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

000002349

Policy instance

Insurance contract or identification number	000002349
Number of Individuals Covered	1445
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $9,436
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,436
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	327
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 $144,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	76
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 $33,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

718769

Policy instance

Insurance contract or identification number	718769
Number of Individuals Covered	2571
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $9,332
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $186,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,332
Insurance broker organization code?	3
Insurance broker name	CHILD HEALTH CORP. OF AMERICA

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

066316

Policy instance

Insurance contract or identification number	066316
Number of Individuals Covered	14
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $5,504
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,504
Insurance broker organization code?	3
Insurance broker name	SCOTT T. RILEY

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BPG56

Policy instance

Insurance contract or identification number	BPG56
Number of Individuals Covered	25
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,549
Total amount of fees paid to insurance company	USD $118
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT & CANCER
Welfare Benefit Premiums Paid to Carrier	USD $31,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $977
Amount paid for insurance broker fees	37
Additional information about fees paid to insurance broker	BONUSES, ETC.
Insurance broker organization code?	3
Insurance broker name	MISC. AGENTS PAID 100 EACH

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	1600
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $45,324
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $686,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	92
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 $40,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	299
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 $126,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	1613
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $648,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	99
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	279
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2457

Policy instance

Insurance contract or identification number	2457
Number of Individuals Covered	125
Insurance policy start date	2010-01-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,458

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2455

Policy instance

Insurance contract or identification number	2455
Number of Individuals Covered	1595
Insurance policy start date	2010-01-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $322,850

DIRECTCARE HMO (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

2458

Policy instance

Insurance contract or identification number	2458
Number of Individuals Covered	223
Insurance policy start date	2010-01-01
Insurance policy end date	2010-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $44,655

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Company Name:	CHILDRENS HEALTH SYSTEM, INC.
Employer identification number (EIN):	541278830
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1984-06-28
Company Identification Number:	0258148
Legal Registered Office Address:	601 CHILDREN'S LANE 601 CHILDRENS LN NORFOLK United States of America (USA) 23507