TRANSFORCE, INC. has sponsored the creation of one or more 401k plans.
Additional information about TRANSFORCE, INC.
| Measure | Date | Value |
|---|
| 2022: TRANSFORCE HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,056 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 1,060 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: TRANSFORCE HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,103 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 1,103 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: TRANSFORCE HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,356 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,116 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 10 |
| 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 | 1,126 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: TRANSFORCE HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,323 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,192 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 8 |
| 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 | 1,200 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: TRANSFORCE HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 864 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 734 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 734 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: TRANSFORCE HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 1,371 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 1,371 |
| Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 460 |
| Total of all active and inactive participants | 2017-12-01 | 1,831 |
| 2016: TRANSFORCE HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 1,371 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 1,371 |
| Number of retired or separated participants receiving benefits | 2016-12-01 | 1,371 |
| Number of other retired or separated participants entitled to future benefits | 2016-12-01 | 460 |
| Total of all active and inactive participants | 2016-12-01 | 3,202 |
| 2015: TRANSFORCE HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 707 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 959 |
| Number of retired or separated participants receiving benefits | 2015-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-12-01 | 0 |
| Total of all active and inactive participants | 2015-12-01 | 959 |
| Total participants, beginning-of-year | 2015-11-01 | 722 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 695 |
| Number of retired or separated participants receiving benefits | 2015-11-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2015-11-01 | 0 |
| Total of all active and inactive participants | 2015-11-01 | 707 |
| 2014: TRANSFORCE HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 435 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 710 |
| Number of retired or separated participants receiving benefits | 2014-11-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2014-11-01 | 0 |
| Total of all active and inactive participants | 2014-11-01 | 722 |
| 2013: TRANSFORCE HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 303 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 435 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 0 |
| Total of all active and inactive participants | 2013-11-01 | 435 |
| 2012: TRANSFORCE HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 308 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 308 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 0 |
| Total of all active and inactive participants | 2012-11-01 | 308 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-11-01 | 0 |
| 2011: TRANSFORCE HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 261 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 308 |
| Number of retired or separated participants receiving benefits | 2011-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-11-01 | 0 |
| Total of all active and inactive participants | 2011-11-01 | 308 |
| 2010: TRANSFORCE HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 238 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 260 |
| Number of retired or separated participants receiving benefits | 2010-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-11-01 | 0 |
| Total of all active and inactive participants | 2010-11-01 | 260 |
| 2009: TRANSFORCE HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 198 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 231 |
| Number of retired or separated participants receiving benefits | 2009-11-01 | 7 |
| Number of other retired or separated participants entitled to future benefits | 2009-11-01 | 0 |
| Total of all active and inactive participants | 2009-11-01 | 238 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-11-01 | 0 |
| 2007: TRANSFORCE HEALTH PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-08-01 | 209 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-08-01 | 201 |
| Number of retired or separated participants receiving benefits | 2007-08-01 | 17 |
| Number of other retired or separated participants entitled to future benefits | 2007-08-01 | 0 |
| Total of all active and inactive participants | 2007-08-01 | 218 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2007-08-01 | 0 |
| Total participants | 2007-08-01 | 218 |
| 2006: TRANSFORCE HEALTH PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-08-01 | 202 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-08-01 | 191 |
| Number of retired or separated participants receiving benefits | 2006-08-01 | 18 |
| Number of other retired or separated participants entitled to future benefits | 2006-08-01 | 0 |
| Total of all active and inactive participants | 2006-08-01 | 209 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2006-08-01 | 0 |
| Total participants | 2006-08-01 | 209 |
| 2005: TRANSFORCE HEALTH PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-08-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-08-01 | 197 |
| Number of retired or separated participants receiving benefits | 2005-08-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2005-08-01 | 0 |
| Total of all active and inactive participants | 2005-08-01 | 202 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2005-08-01 | 0 |
| Total participants | 2005-08-01 | 202 |
| 2004: TRANSFORCE HEALTH PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-08-01 | 79 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-08-01 | 116 |
| Number of retired or separated participants receiving benefits | 2004-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-08-01 | 0 |
| Total of all active and inactive participants | 2004-08-01 | 116 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2004-08-01 | 0 |
| Total participants | 2004-08-01 | 116 |
| 2003: TRANSFORCE HEALTH PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-08-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-08-01 | 79 |
| Number of retired or separated participants receiving benefits | 2003-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-08-01 | 0 |
| Total of all active and inactive participants | 2003-08-01 | 79 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2003-08-01 | 0 |
| Total participants | 2003-08-01 | 79 |
| 2002: TRANSFORCE HEALTH PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-08-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-08-01 | 108 |
| Number of retired or separated participants receiving benefits | 2002-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-08-01 | 0 |
| Total of all active and inactive participants | 2002-08-01 | 108 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2002-08-01 | 0 |
| Total participants | 2002-08-01 | 108 |
| 2022: TRANSFORCE HEALTH 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 benefit arrangement – Insurance | Yes |
| 2021: TRANSFORCE HEALTH 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 benefit arrangement – Insurance | Yes |
| 2020: TRANSFORCE HEALTH 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 benefit arrangement – Insurance | Yes |
| 2019: TRANSFORCE HEALTH 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 benefit arrangement – Insurance | Yes |
| 2018: TRANSFORCE HEALTH 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 benefit arrangement – Insurance | Yes |
| 2017: TRANSFORCE HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: TRANSFORCE HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: TRANSFORCE HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Submission has been amended | No |
| 2015-12-01 | This submission is the final filing | No |
| 2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-12-01 | Plan is a collectively bargained plan | No |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: TRANSFORCE HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: TRANSFORCE HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: TRANSFORCE HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: TRANSFORCE HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Submission has been amended | No |
| 2011-11-01 | This submission is the final filing | No |
| 2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-11-01 | Plan is a collectively bargained plan | No |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: TRANSFORCE HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Submission has been amended | No |
| 2010-11-01 | This submission is the final filing | No |
| 2010-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-11-01 | Plan is a collectively bargained plan | No |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: TRANSFORCE HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Submission has been amended | No |
| 2009-11-01 | This submission is the final filing | No |
| 2009-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-11-01 | Plan is a collectively bargained plan | No |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: TRANSFORCE HEALTH PLAN 2007 form 5500 responses |
|---|
| 2007-08-01 | Type of plan entity | Single employer plan |
| 2007-08-01 | Submission has been amended | No |
| 2007-08-01 | This submission is the final filing | No |
| 2007-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-08-01 | Plan is a collectively bargained plan | No |
| 2007-08-01 | Plan funding arrangement – Insurance | Yes |
| 2007-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: TRANSFORCE HEALTH PLAN 2006 form 5500 responses |
|---|
| 2006-08-01 | Type of plan entity | Single employer plan |
| 2006-08-01 | Submission has been amended | No |
| 2006-08-01 | This submission is the final filing | No |
| 2006-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-08-01 | Plan is a collectively bargained plan | No |
| 2006-08-01 | Plan funding arrangement – Insurance | Yes |
| 2006-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: TRANSFORCE HEALTH PLAN 2005 form 5500 responses |
|---|
| 2005-08-01 | Type of plan entity | Single employer plan |
| 2005-08-01 | Submission has been amended | No |
| 2005-08-01 | This submission is the final filing | No |
| 2005-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-08-01 | Plan is a collectively bargained plan | No |
| 2005-08-01 | Plan funding arrangement – Insurance | Yes |
| 2005-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: TRANSFORCE HEALTH PLAN 2004 form 5500 responses |
|---|
| 2004-08-01 | Type of plan entity | Single employer plan |
| 2004-08-01 | Submission has been amended | No |
| 2004-08-01 | This submission is the final filing | No |
| 2004-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-08-01 | Plan is a collectively bargained plan | No |
| 2004-08-01 | Plan funding arrangement – Insurance | Yes |
| 2004-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: TRANSFORCE HEALTH PLAN 2003 form 5500 responses |
|---|
| 2003-08-01 | Type of plan entity | Single employer plan |
| 2003-08-01 | Submission has been amended | No |
| 2003-08-01 | This submission is the final filing | No |
| 2003-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-08-01 | Plan is a collectively bargained plan | No |
| 2003-08-01 | Plan funding arrangement – Insurance | Yes |
| 2003-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: TRANSFORCE HEALTH PLAN 2002 form 5500 responses |
|---|
| 2002-08-01 | Type of plan entity | Single employer plan |
| 2002-08-01 | Submission has been amended | No |
| 2002-08-01 | This submission is the final filing | No |
| 2002-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-08-01 | Plan is a collectively bargained plan | No |
| 2002-08-01 | Plan funding arrangement – Insurance | Yes |
| 2002-08-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 94557 |
| Policy instance | 3 |
| Insurance contract or identification number | 94557 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2023-11-30 | | Total amount of commissions paid to insurance broker | USD $8,617 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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 | 922407 |
| Policy instance | 2 |
| Insurance contract or identification number | 922407 | | Number of Individuals Covered | 1616 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $77,155 | | Total amount of fees paid to insurance company | USD $155,000 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,349,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 28108 |
| Policy instance | 1 |
| Insurance contract or identification number | 28108 | | Number of Individuals Covered | 296 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $10,423 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $101,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD134210 |
| Policy instance | 4 |
| Insurance contract or identification number | LTD134210 | | Number of Individuals Covered | 935 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $287,813 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM,ACCIDENTAL DEATH AND DISMEMBERMENT,HOSPITAL,CRITICAL ILLNESS,ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $832,486 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 28108 |
| Policy instance | 2 |
| Insurance contract or identification number | 28108 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $15,466 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $120,694 | | 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 | 922407 |
| Policy instance | 4 |
| Insurance contract or identification number | 922407 | | Number of Individuals Covered | 2136 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $88,104 | | Total amount of fees paid to insurance company | USD $240,575 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,005,929 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 94557 |
| Policy instance | 5 |
| Insurance contract or identification number | 94557 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $7,842 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600433 |
| Policy instance | 3 |
| Insurance contract or identification number | 600433 | | Number of Individuals Covered | 1056 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681445G |
| Policy instance | 1 |
| Insurance contract or identification number | 681445G | | Number of Individuals Covered | 962 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $205,088 | | Total amount of fees paid to insurance company | USD $166 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,158,426 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 32198 |
| Policy instance | 6 |
| Insurance contract or identification number | 32198 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2022-11-30 | | Total amount of commissions paid to insurance broker | USD $1,400 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,085 | | 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 | 600433 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681445G |
| Policy instance | 1 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 28108 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) |
| Policy contract number | 94557 |
| Policy instance | 5 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 32198 |
| Policy instance | 6 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 922407 |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-524 |
| Policy instance | 2 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681445G |
| Policy instance | 3 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600433 |
| Policy instance | 5 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 28108 |
| Policy instance | 4 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681445G |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 1 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600433 |
| Policy instance | 5 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 28108 |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | VAC-460200 |
| Policy instance | 4 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600433 |
| Policy instance | 6 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 28108 |
| Policy instance | 5 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00614556-0001 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 1 |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | G00614556-0001 |
| Policy instance | 3 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | VAC-460200 |
| Policy instance | 4 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 773403 |
| Policy instance | 6 |
| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 28108 |
| Policy instance | 5 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 8 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS326455 |
| Policy instance | 1 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1014909 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-524 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL132344 |
| Policy instance | 5 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 000600107 |
| Policy instance | 6 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | C7402 |
| Policy instance | 7 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 000600107 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL132344 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG177416 |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-524 |
| Policy instance | 5 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | C7402 |
| Policy instance | 6 |
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | V253863 |
| Policy instance | 7 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | C7402 |
| Policy instance | 9 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 10 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VPS326455 |
| Policy instance | 8 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 2 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 81763407 |
| Policy instance | 1 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 000600107 |
| Policy instance | 4 |
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 17FE |
| Policy instance | 5 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 132344 |
| Policy instance | 6 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1014909 |
| Policy instance | 7 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 3 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) |
| Policy contract number | 102673 |
| Policy instance | 2 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 000600107 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VIP530660 |
| Policy instance | 6 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1014909 |
| Policy instance | 5 |
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 17FE |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 2 |
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 17FE |
| Policy instance | 3 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1014909 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VIP530660 |
| Policy instance | 5 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 00600107 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VIP530660 |
| Policy instance | 4 |
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 17FE |
| Policy instance | 3 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 000600107 |
| Policy instance | 2 |
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95343 ) |
| Policy contract number | US395622 |
| Policy instance | 2 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 471505 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 3 |
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 17FE |
| Policy instance | 4 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600107 |
| Policy instance | 5 |
| NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
| Policy contract number | FR1071 |
| Policy instance | 6 |
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3325424 |
| Policy instance | 7 |
| CIGNA HEALTHCARE OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95383 ) |
| Policy contract number | 3325424 |
| Policy instance | 6 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600107 |
| Policy instance | 8 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 81345 |
| Policy instance | 11 |
| CIGNA HEALTHCARE OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95383 ) |
| Policy contract number | 3325424 |
| Policy instance | 4 |
| CIGNA HEALTHCARE OF KANSAS CITY, INC. (National Association of Insurance Commissioners NAIC id number: 95207 ) |
| Policy contract number | 3325424 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 71870 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17265-0 |
| Policy instance | 9 |
| CIGNA HEALTHCARE OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95383 ) |
| Policy contract number | 3325424 |
| Policy instance | 5 |
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17265-2 |
| Policy instance | 10 |
| CIGNA HEALTHCARE OF MID ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95599 ) |
| Policy contract number | 3325424 |
| Policy instance | 9 |
| CIGNA HEALTHCARE OF KANSAS CITY, INC. (National Association of Insurance Commissioners NAIC id number: 95207 ) |
| Policy contract number | 3325424 |
| Policy instance | 8 |
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3325424 |
| Policy instance | 16 |
| CIGNA HEALTHCARE OF NJ (National Association of Insurance Commissioners NAIC id number: 95500 ) |
| Policy contract number | 3325424 |
| Policy instance | 11 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| CIGNA HEALTHCARE OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 6229 ) |
| Policy contract number | 3325424 |
| Policy instance | 2 |
| CIGNA HEALTHCARE OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95383 ) |
| Policy contract number | 3325424 |
| Policy instance | 3 |
| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 3325424 |
| Policy instance | 5 |
| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 3325424 |
| Policy instance | 6 |
| CIGNA HEALTHCARE OF ARIZONA, INC. (National Association of Insurance Commissioners NAIC id number: 95125 ) |
| Policy contract number | 3325424 |
| Policy instance | 4 |
| CIGNA HEALTHCARE OF NJ (National Association of Insurance Commissioners NAIC id number: 95500 ) |
| Policy contract number | 3325424 |
| Policy instance | 10 |
| CIGNA HEALTHCARE OF INDIANA, INC. (National Association of Insurance Commissioners NAIC id number: 95525 ) |
| Policy contract number | 3325424 |
| Policy instance | 12 |
| CIGNA HEALTHCARE OF PA (National Association of Insurance Commissioners NAIC id number: 95121 ) |
| Policy contract number | 3325424 |
| Policy instance | 13 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 81345 |
| Policy instance | 21 |
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17265-0 |
| Policy instance | 20 |
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17265-2 |
| Policy instance | 19 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 6320 |
| Policy instance | 18 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600107 |
| Policy instance | 17 |
| CIGNA HEALTHCARE OF ILLINOIS, INC. (National Association of Insurance Commissioners NAIC id number: 95602 ) |
| Policy contract number | 3325424 |
| Policy instance | 7 |
| CIGNA HEALTHCARE OF TENNESSEE, INC (National Association of Insurance Commissioners NAIC id number: 95606 ) |
| Policy contract number | 3325424 |
| Policy instance | 15 |
| CIGNA HEALTHCARE OF TENNESSEE, INC (National Association of Insurance Commissioners NAIC id number: 95606 ) |
| Policy contract number | 3325424 |
| Policy instance | 14 |
| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 3325424 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 6320 |
| Policy instance | 18 |
| CIGNA HEALTHCARE OF ILLINOIS, INC. (National Association of Insurance Commissioners NAIC id number: 95602 ) |
| Policy contract number | 3325424 |
| Policy instance | 4 |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) |
| Policy contract number | 81345 |
| Policy instance | 20 |
| CIGNA HEALTHCARE OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 6229 ) |
| Policy contract number | 3325424 |
| Policy instance | 3 |
| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 ) |
| Policy contract number | 3325424 |
| Policy instance | 10 |
| CIGNA HEALTHCARE OF INDIANA, INC. (National Association of Insurance Commissioners NAIC id number: 95525 ) |
| Policy contract number | 3325424 |
| Policy instance | 5 |
| CIGNA HEALTHCARE OF ARIZONA, INC. (National Association of Insurance Commissioners NAIC id number: 95125 ) |
| Policy contract number | 3325424 |
| Policy instance | 14 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 600107 |
| Policy instance | 16 |
| CIGNA HEALTHCARE OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95383 ) |
| Policy contract number | 3325424 |
| Policy instance | 13 |
| CIGNA HEALTHCARE OF TENNESSEE, INC (National Association of Insurance Commissioners NAIC id number: 95606 ) |
| Policy contract number | 3325424 |
| Policy instance | 12 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 6320 |
| Policy instance | 17 |
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 17265-0 |
| Policy instance | 19 |
| CIGNA HEALTHCARE OF TENNESSEE, INC (National Association of Insurance Commissioners NAIC id number: 95606 ) |
| Policy contract number | 3325424 |
| Policy instance | 11 |
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3325454 |
| Policy instance | 15 |
| CIGNA HEALTHCARE OF NJ (National Association of Insurance Commissioners NAIC id number: 95500 ) |
| Policy contract number | 3325424 |
| Policy instance | 9 |
| CIGNA HEALTHCARE OF KANSAS CITY, INC. (National Association of Insurance Commissioners NAIC id number: 95207 ) |
| Policy contract number | 3325424 |
| Policy instance | 6 |
| CIGNA HEALTHCARE OF MID ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95599 ) |
| Policy contract number | 3325424 |
| Policy instance | 7 |
| CIGNA HEALTHCARE OF NJ (National Association of Insurance Commissioners NAIC id number: 95500 ) |
| Policy contract number | 3325424 |
| Policy instance | 8 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 6320 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 168829 |
| Policy instance | 4 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 168829 |
| Policy instance | 3 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 6320 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 168829 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 ) |
| Policy contract number | 130871 |
| Policy instance | 3 |
| DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 ) |
| Policy contract number | 6320 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 30790-1019 |
| Policy instance | 1 |
| UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 ) |
| Policy contract number | 130871 |
| Policy instance | 1 |
