401k Plan data: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN plan

GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN
Plan identification number	501

GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: GWINNETT HEALTH SYSTEM, INC.

Employer identification number (EIN): 582135755

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 SHANNON BANNA 2020-07-14
501 2018-01-01 STEPHEN A. NADEAU 2019-07-29
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 STEPHEN A. NADEAU
501 2011-01-01 STEPHEN A NADEAU
501 2009-01-01 STEPHEN A NADEAU

Plan Statistics for GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN

Measure Date Value
2019: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 3,661
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 3,706
Number of retired or separated participants receiving benefits 2019-01-01 17
Total of all active and inactive participants 2019-01-01 3,723
2018: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 3,482
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 3,592
Number of retired or separated participants receiving benefits 2018-01-01 26
Total of all active and inactive participants 2018-01-01 3,618
2017: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3,541
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3,446
Number of retired or separated participants receiving benefits 2017-01-01 36
Total of all active and inactive participants 2017-01-01 3,482
2016: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 3,407
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 3,515
Number of retired or separated participants receiving benefits 2016-01-01 26
Total of all active and inactive participants 2016-01-01 3,541
2015: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 3,209
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 3,383
Number of retired or separated participants receiving benefits 2015-01-01 24
Total of all active and inactive participants 2015-01-01 3,407
2014: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 3,243
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3,178
Number of retired or separated participants receiving benefits 2014-01-01 31
Total of all active and inactive participants 2014-01-01 3,209
2013: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3,084
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 3,221
Number of retired or separated participants receiving benefits 2013-01-01 22
Total of all active and inactive participants 2013-01-01 3,243
2012: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2,955
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 3,050
Number of retired or separated participants receiving benefits 2012-01-01 34
Total of all active and inactive participants 2012-01-01 3,084
Total participants 2012-01-01 0
2011: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,987
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2,923
Number of retired or separated participants receiving benefits 2011-01-01 32
Total of all active and inactive participants 2011-01-01 2,955
Total participants 2011-01-01 2,955
2009: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2,837
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2,927
Number of retired or separated participants receiving benefits 2009-01-01 26
Total of all active and inactive participants 2009-01-01 2,953
Total participants 2009-01-01 2,953

Measure	Date	Value
2019: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	3,661
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	3,706
Number of retired or separated participants receiving benefits	2019-01-01	17
Total of all active and inactive participants	2019-01-01	3,723
2018: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3,482
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	3,592
Number of retired or separated participants receiving benefits	2018-01-01	26
Total of all active and inactive participants	2018-01-01	3,618
2017: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3,541
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3,446
Number of retired or separated participants receiving benefits	2017-01-01	36
Total of all active and inactive participants	2017-01-01	3,482
2016: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3,407
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	3,515
Number of retired or separated participants receiving benefits	2016-01-01	26
Total of all active and inactive participants	2016-01-01	3,541
2015: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	3,209
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	3,383
Number of retired or separated participants receiving benefits	2015-01-01	24
Total of all active and inactive participants	2015-01-01	3,407
2014: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	3,243
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3,178
Number of retired or separated participants receiving benefits	2014-01-01	31
Total of all active and inactive participants	2014-01-01	3,209
2013: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3,084
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	3,221
Number of retired or separated participants receiving benefits	2013-01-01	22
Total of all active and inactive participants	2013-01-01	3,243
2012: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,955
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	3,050
Number of retired or separated participants receiving benefits	2012-01-01	34
Total of all active and inactive participants	2012-01-01	3,084
Total participants	2012-01-01	0
2011: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,987
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,923
Number of retired or separated participants receiving benefits	2011-01-01	32
Total of all active and inactive participants	2011-01-01	2,955
Total participants	2011-01-01	2,955
2009: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2,837
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2,927
Number of retired or separated participants receiving benefits	2009-01-01	26
Total of all active and inactive participants	2009-01-01	2,953
Total participants	2009-01-01	2,953

Form 5500 Responses for GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN

2019: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: GWINNETT HEALTH SYSTEM FLEXIBLE 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: GWINNETT HEALTH SYSTEM FLEXIBLE 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: GWINNETT HEALTH SYSTEM FLEXIBLE 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: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GWINNETT HEALTH SYSTEM FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	3072
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $26,948
Total amount of fees paid to insurance company	USD $9,803
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $538,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,948
Amount paid for insurance broker fees	9803
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3574
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $20,708
Total amount of fees paid to insurance company	USD $3,209
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $172,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,708
Amount paid for insurance broker fees	3209
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	7

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3574
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $3,765
Total amount of fees paid to insurance company	USD $570
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $31,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,765
Amount paid for insurance broker fees	570
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766

Policy instance

Insurance contract or identification number	9682766
Number of Individuals Covered	3307
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $14,657
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,657
Insurance broker organization code?	3

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

Policy contract number

0149701,0149702

Policy instance

Insurance contract or identification number	0149701,0149702
Number of Individuals Covered	7750
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $114,160
Total amount of fees paid to insurance company	USD $30,581
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,026,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $114,160
Amount paid for insurance broker fees	30581
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920315

Policy instance

Insurance contract or identification number	9920315
Number of Individuals Covered	2782
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $27,888
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $283,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,888
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920620

Policy instance

Insurance contract or identification number	9920620
Number of Individuals Covered	8
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $61
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920612

Policy instance

Insurance contract or identification number	9920612
Number of Individuals Covered	13
Insurance policy start date	2019-01-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $42
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $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 $42
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920620

Policy instance

Insurance contract or identification number	9920620
Number of Individuals Covered	8
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $137
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $137
Insurance broker organization code?	3

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3551
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,208
Total amount of fees paid to insurance company	USD $567
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $43,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,208
Amount paid for insurance broker fees	567
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766

Policy instance

Insurance contract or identification number	9682766
Number of Individuals Covered	3395
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $26,944
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $289,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,944
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920315

Policy instance

Insurance contract or identification number	9920315
Number of Individuals Covered	2421
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $39,510
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $398,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,510
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920612

Policy instance

Insurance contract or identification number	9920612
Number of Individuals Covered	12
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $65
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $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 $65
Insurance broker organization code?	3

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

Policy contract number

0149701,0149702

Policy instance

Insurance contract or identification number	0149701,0149702
Number of Individuals Covered	7545
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $166,605
Total amount of fees paid to insurance company	USD $79,403
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,070,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $166,605
Amount paid for insurance broker fees	79403
Insurance broker organization code?	3

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	3121
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $37,406
Total amount of fees paid to insurance company	USD $9,771
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $748,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,406
Amount paid for insurance broker fees	9771
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3551
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $27,480
Total amount of fees paid to insurance company	USD $2,243
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $228,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,480
Amount paid for insurance broker fees	2243
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3446
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,603
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $50,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,603
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920612

Policy instance

Insurance contract or identification number	9920612
Number of Individuals Covered	12
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $62
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920620

Policy instance

Insurance contract or identification number	9920620
Number of Individuals Covered	12
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $98
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $98
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920315

Policy instance

Insurance contract or identification number	9920315
Number of Individuals Covered	2388
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $36,050
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $398,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,050
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

0149701,0149702

Policy instance

Insurance contract or identification number	0149701,0149702
Number of Individuals Covered	7673
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $140,034
Total amount of fees paid to insurance company	USD $41,810
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,066,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $140,034
Amount paid for insurance broker fees	41810
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766

Policy instance

Insurance contract or identification number	9682766
Number of Individuals Covered	3535
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,920
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $287,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,920
Insurance broker organization code?	3
Insurance broker name	LOCKTON CO. DUNNING SERIES - DALLAS

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3446
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,445
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $218,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,445
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	3038
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $53,844
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $892,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,844
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9920315,9920612

Policy instance

Insurance contract or identification number	9920315,9920612
Number of Individuals Covered	1423
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $17,367
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $211,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,367
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3403
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $24,340
Total amount of fees paid to insurance company	USD $3,927
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $202,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,340
Amount paid for insurance broker fees	3927
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	3014
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $41,713
Total amount of fees paid to insurance company	USD $16,101
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $834,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,713
Amount paid for insurance broker fees	16101
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3403
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,650
Total amount of fees paid to insurance company	USD $912
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $47,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,650
Amount paid for insurance broker fees	912
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766

Policy instance

Insurance contract or identification number	9682766
Number of Individuals Covered	4035
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $33,270
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $320,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,270
Insurance broker organization code?	3
Insurance broker name	LOCKTON CO. DUNNING SERIES - DALLAS

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

Policy contract number

0149701,0149702

Policy instance

Insurance contract or identification number	0149701,0149702
Number of Individuals Covered	5629
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $127,211
Total amount of fees paid to insurance company	USD $37,771
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,559,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $127,100
Amount paid for insurance broker fees	37684
Additional information about fees paid to insurance broker	37,641 SUPPLEMENTAL COMPENSATION, 43 NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766,9748963

Policy instance

Insurance contract or identification number	9682766,9748963
Number of Individuals Covered	5449
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $32,801
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $393,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,801
Insurance broker organization code?	3
Insurance broker name	LOCKTON CO. DUNNING SERIES - DALLAS

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3365
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,484
Total amount of fees paid to insurance company	USD $794
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $45,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,484
Amount paid for insurance broker fees	794
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	2974
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $40,362
Total amount of fees paid to insurance company	USD $14,067
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $807,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,362
Amount paid for insurance broker fees	14067
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3365
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $23,681
Total amount of fees paid to insurance company	USD $3,517
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $197,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,681
Amount paid for insurance broker fees	3517
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

0149701

Policy instance

Insurance contract or identification number	0149701
Number of Individuals Covered	5518
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $118,071
Total amount of fees paid to insurance company	USD $31,097
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,368,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $118,071
Amount paid for insurance broker fees	31097
Additional information about fees paid to insurance broker	30,931 SUPPLEMENTAL COMMMISSION, 132 ADMIN FEES, 34 NON-MONETARY COMP
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

0149701

Policy instance

Insurance contract or identification number	0149701
Number of Individuals Covered	5515
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $102,476
Total amount of fees paid to insurance company	USD $40,990
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,237,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $102,476
Amount paid for insurance broker fees	40990
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766,9748963

Policy instance

Insurance contract or identification number	9682766,9748963
Number of Individuals Covered	5445
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $41,642
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $385,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,642
Insurance broker organization code?	3
Insurance broker name	LOCKTON CO. DUNNING SERIES - DALLAS

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	2912
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $39,645
Total amount of fees paid to insurance company	USD $10,011
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $792,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,645
Amount paid for insurance broker fees	10011
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3283
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $23,848
Total amount of fees paid to insurance company	USD $2,594
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $198,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,848
Amount paid for insurance broker fees	2594
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3283
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,474
Total amount of fees paid to insurance company	USD $586
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $44,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,474
Amount paid for insurance broker fees	586
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

03777, 75857

Policy instance

Insurance contract or identification number	03777, 75857
Number of Individuals Covered	3058
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $83,761
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,000,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83,761
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3176
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $22,619
Total amount of fees paid to insurance company	USD $1,059
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $181,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,619
Amount paid for insurance broker fees	1059
Additional information about fees paid to insurance broker	SUPP. COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	2770
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $38,028
Total amount of fees paid to insurance company	USD $4,075
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $700,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,028
Amount paid for insurance broker fees	4075
Additional information about fees paid to insurance broker	SUPP. COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3176
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,107
Total amount of fees paid to insurance company	USD $239
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $41,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,107
Amount paid for insurance broker fees	239
Additional information about fees paid to insurance broker	SUPP. COMMISSION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766,9748963

Policy instance

Insurance contract or identification number	9682766,9748963
Number of Individuals Covered	5062
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $35,277
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $324,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,277
Insurance broker organization code?	3
Insurance broker name	LOCKTON CO. DUNNING SERIES - DALLAS

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

05857

Policy instance

Insurance contract or identification number	05857
Number of Individuals Covered	272
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,359
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766,9748963

Policy instance

Insurance contract or identification number	9682766,9748963
Number of Individuals Covered	4760
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $34,327
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $341,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3122
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,413
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $40,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	2698
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $43,445
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $688,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3122
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $23,971
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $180,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

11-03777

Policy instance

Insurance contract or identification number	11-03777
Number of Individuals Covered	2656
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $75,001
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,785,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

11-03777

Policy instance

Insurance contract or identification number	11-03777
Number of Individuals Covered	2706
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $57,788
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,844,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

9682766,9748963

Policy instance

Insurance contract or identification number	9682766,9748963
Number of Individuals Covered	4932
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $42,851
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $397,684
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK980178

Policy instance

Insurance contract or identification number	OK980178
Number of Individuals Covered	3217
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,562
Total amount of fees paid to insurance company	USD $1,164
Other welfare benefits provided	AD&D, MEDICAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $38,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

LK980117

Policy instance

Insurance contract or identification number	LK980117
Number of Individuals Covered	2793
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $32,328
Total amount of fees paid to insurance company	USD $21,565
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $646,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX980139

Policy instance

Insurance contract or identification number	FLX980139
Number of Individuals Covered	3217
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $20,205
Total amount of fees paid to insurance company	USD $5,153
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $168,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

05857

Policy instance

Insurance contract or identification number	05857
Number of Individuals Covered	284
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,579
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GWINNETT HEALTH SYSTEM, INC.
Employer identification number (EIN):	582135755
NAIC Classification:	622000
NAIC Description:	Hospitals

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2019-01-01	SHANNON BANNA	2020-07-14
501	2018-01-01	STEPHEN A. NADEAU	2019-07-29
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	STEPHEN A. NADEAU
501	2011-01-01	STEPHEN A NADEAU
501	2009-01-01	STEPHEN A NADEAU