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| Plan Name | COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | COADVANTAGE RESOURCES INC |
| Employer identification number (EIN): | 593434670 |
| NAIC Classification: | 561300 |
Additional information about COADVANTAGE RESOURCES INC
| Jurisdiction of Incorporation: | State of Delaware Division of Corporations |
| Incorporation Date: | |
| Company Identification Number: | 4815824 |
More information about COADVANTAGE RESOURCES INC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-10-01 | KRISTEN APPLEMAN | |||
| 501 | 2022-10-01 | ||||
| 501 | 2022-10-01 | LORI MARTIN | |||
| 501 | 2021-10-01 | ||||
| 501 | 2021-10-01 | LORI MARTIN | |||
| 501 | 2020-10-01 | ||||
| 501 | 2019-10-01 | ||||
| 501 | 2019-10-01 | ||||
| 501 | 2018-10-01 | ||||
| 501 | 2018-10-01 | ||||
| 501 | 2017-10-01 | ||||
| 501 | 2017-10-01 | ||||
| 501 | 2016-10-01 | PETER GRABOWSKI | |||
| 501 | 2015-10-01 | MIKE MASEDA | |||
| 501 | 2014-10-01 | JEFFREY MARSHALL | |||
| 501 | 2013-10-01 | JEFFREY SJOBECK | |||
| 501 | 2012-10-01 | JEFFREY SJOBECK | JEFFREY SJOBECK | 2014-10-06 | |
| 501 | 2011-10-01 | JEFFREY J SJOBACK | |||
| 501 | 2009-10-01 | JEFFREY J SJOBECK | |||
| 501 | 2009-10-01 | MARK LOWREY | |||
| 501 | 2009-07-01 | JEFFREY J SJOBECK | |||
| 501 | 2009-07-01 | MARK LOWREY |
| Measure | Date | Value |
|---|---|---|
| 2016 : COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2016 401k financial data | ||
| Total unrealized appreciation/depreciation of assets | 2016-09-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-09-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-09-30 | $0 |
| Total income from all sources (including contributions) | 2016-09-30 | $98,653,584 |
| Total loss/gain on sale of assets | 2016-09-30 | $0 |
| Total of all expenses incurred | 2016-09-30 | $92,837,274 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-09-30 | $91,630,394 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-09-30 | $96,417,910 |
| Value of total assets at end of year | 2016-09-30 | $10,132,505 |
| Value of total assets at beginning of year | 2016-09-30 | $4,316,195 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-09-30 | $1,206,880 |
| Total interest from all sources | 2016-09-30 | $5,655 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-09-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-09-30 | No |
| Administrative expenses professional fees incurred | 2016-09-30 | $1,206,880 |
| Was this plan covered by a fidelity bond | 2016-09-30 | Yes |
| Value of fidelity bond cover | 2016-09-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-09-30 | No |
| Contributions received from participants | 2016-09-30 | $38,693,787 |
| Participant contributions at end of year | 2016-09-30 | $5,562,851 |
| Participant contributions at beginning of year | 2016-09-30 | $1,016,332 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2016-09-30 | $2,871,494 |
| Other income not declared elsewhere | 2016-09-30 | $2,230,019 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-09-30 | No |
| Value of net income/loss | 2016-09-30 | $5,816,310 |
| Value of net assets at end of year (total assets less liabilities) | 2016-09-30 | $10,132,505 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-09-30 | $4,316,195 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-09-30 | $4,352,358 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-09-30 | $1,896,357 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-09-30 | $1,896,357 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-09-30 | $5,655 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-09-30 | $88,758,900 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-09-30 | No |
| Contributions received in cash from employer | 2016-09-30 | $57,724,123 |
| Employer contributions (assets) at end of year | 2016-09-30 | $217,296 |
| Employer contributions (assets) at beginning of year | 2016-09-30 | $1,403,506 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-09-30 | No |
| Did the plan have assets held for investment | 2016-09-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-09-30 | Unqualified |
| Accountancy firm name | 2016-09-30 | CLIFTON LARSON ALLEN |
| Accountancy firm EIN | 2016-09-30 | 410746749 |
| 2015 : COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2015 401k financial data | ||
| Total unrealized appreciation/depreciation of assets | 2015-09-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-09-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-09-30 | $0 |
| Total income from all sources (including contributions) | 2015-09-30 | $70,141,621 |
| Total loss/gain on sale of assets | 2015-09-30 | $0 |
| Total of all expenses incurred | 2015-09-30 | $72,911,874 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-09-30 | $70,920,491 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-09-30 | $69,536,264 |
| Value of total assets at end of year | 2015-09-30 | $4,316,195 |
| Value of total assets at beginning of year | 2015-09-30 | $7,086,448 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-09-30 | $1,991,383 |
| Total interest from all sources | 2015-09-30 | $5,823 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-09-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-09-30 | No |
| Was this plan covered by a fidelity bond | 2015-09-30 | Yes |
| Value of fidelity bond cover | 2015-09-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-09-30 | No |
| Contributions received from participants | 2015-09-30 | $29,073,943 |
| Participant contributions at end of year | 2015-09-30 | $1,016,332 |
| Participant contributions at beginning of year | 2015-09-30 | $655,076 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-09-30 | $2,544,770 |
| Other income not declared elsewhere | 2015-09-30 | $599,534 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-09-30 | No |
| Value of net income/loss | 2015-09-30 | $-2,770,253 |
| Value of net assets at end of year (total assets less liabilities) | 2015-09-30 | $4,316,195 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-09-30 | $7,086,448 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-09-30 | $1,896,357 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-09-30 | $5,526,743 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-09-30 | $5,526,743 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-09-30 | $5,823 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-09-30 | $68,375,721 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-09-30 | No |
| Contributions received in cash from employer | 2015-09-30 | $40,462,321 |
| Employer contributions (assets) at end of year | 2015-09-30 | $1,403,506 |
| Employer contributions (assets) at beginning of year | 2015-09-30 | $904,629 |
| Contract administrator fees | 2015-09-30 | $1,991,383 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-09-30 | No |
| Did the plan have assets held for investment | 2015-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-09-30 | Unqualified |
| Accountancy firm name | 2015-09-30 | CLIFTON LARSON ALLEN |
| Accountancy firm EIN | 2015-09-30 | 410746749 |
| 2014 : COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2014 401k financial data | ||
| Total unrealized appreciation/depreciation of assets | 2014-09-30 | $0 |
| Total transfer of assets to this plan | 2014-09-30 | $5,621,629 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-09-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-09-30 | $0 |
| Total income from all sources (including contributions) | 2014-09-30 | $59,633,795 |
| Total loss/gain on sale of assets | 2014-09-30 | $0 |
| Total of all expenses incurred | 2014-09-30 | $58,168,976 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-09-30 | $57,981,467 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-09-30 | $59,327,682 |
| Value of total assets at end of year | 2014-09-30 | $7,086,448 |
| Value of total assets at beginning of year | 2014-09-30 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-09-30 | $187,509 |
| Total interest from all sources | 2014-09-30 | $6,705 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-09-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-09-30 | No |
| Was this plan covered by a fidelity bond | 2014-09-30 | Yes |
| Value of fidelity bond cover | 2014-09-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-09-30 | Yes |
| Were there any nonexempt tranactions with any party-in-interest | 2014-09-30 | No |
| Contributions received from participants | 2014-09-30 | $25,456,766 |
| Participant contributions at end of year | 2014-09-30 | $655,076 |
| Other income not declared elsewhere | 2014-09-30 | $299,408 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
| Value of net income/loss | 2014-09-30 | $1,464,819 |
| Value of net assets at end of year (total assets less liabilities) | 2014-09-30 | $7,086,448 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-09-30 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-09-30 | $5,526,743 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-09-30 | $6,705 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-09-30 | $57,981,467 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-09-30 | No |
| Contributions received in cash from employer | 2014-09-30 | $33,870,916 |
| Employer contributions (assets) at end of year | 2014-09-30 | $904,629 |
| Contract administrator fees | 2014-09-30 | $187,509 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-09-30 | No |
| Did the plan have assets held for investment | 2014-09-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-09-30 | Yes |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-09-30 | Unqualified |
| Accountancy firm name | 2014-09-30 | CLIFTONLARSONALLEN |
| Accountancy firm EIN | 2014-09-30 | 410746749 |
| 2022: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-10-01 | Type of plan entity | Single employer plan |
| 2022-10-01 | Submission has been amended | No |
| 2022-10-01 | This submission is the final filing | No |
| 2022-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-10-01 | Plan is a collectively bargained plan | No |
| 2022-10-01 | Plan funding arrangement – Insurance | Yes |
| 2022-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2021 form 5500 responses | ||
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Submission has been amended | No |
| 2021-10-01 | This submission is the final filing | No |
| 2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-10-01 | Plan is a collectively bargained plan | No |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2020 form 5500 responses | ||
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Submission has been amended | No |
| 2020-10-01 | This submission is the final filing | No |
| 2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-10-01 | Plan is a collectively bargained plan | No |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2019 form 5500 responses | ||
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Submission has been amended | No |
| 2019-10-01 | This submission is the final filing | No |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-10-01 | Plan is a collectively bargained plan | No |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2018 form 5500 responses | ||
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Submission has been amended | No |
| 2018-10-01 | This submission is the final filing | No |
| 2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-10-01 | Plan is a collectively bargained plan | No |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2017 form 5500 responses | ||
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2016 form 5500 responses | ||
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2015 form 5500 responses | ||
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan funding arrangement – Trust | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement - Trust | Yes |
| 2014: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2014 form 5500 responses | ||
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan funding arrangement – Trust | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement - Trust | Yes |
| 2013: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2013 form 5500 responses | ||
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan funding arrangement – Trust | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement - Trust | Yes |
| 2012: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2012 form 5500 responses | ||
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | Yes |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2011 form 5500 responses | ||
| 2011-10-01 | Type of plan entity | Mulitple employer plan |
| 2011-10-01 | Submission has been amended | Yes |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: COADVANTAGE RESOURCES INC GROUP BENEFITS PLAN 2009 form 5500 responses | ||
| 2009-10-01 | Type of plan entity | Mulitple employer plan |
| 2009-10-01 | Submission has been amended | Yes |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | No |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Type of plan entity | Mulitple employer plan |
| 2009-07-01 | Submission has been amended | Yes |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 ) | |
| Policy contract number | 0727530HNO |
| Policy instance | 4 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) | |
| Policy contract number | 7236 |
| Policy instance | 16 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 68899 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 68899 |
| Policy instance | 2 |
| TEXAS HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16121 ) | |
| Policy contract number | 0727530TH |
| Policy instance | 3 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0727530 |
| Policy instance | 5 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | R23218 |
| Policy instance | 6 |
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |
| Policy contract number | L00733 |
| Policy instance | 7 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 603670 |
| Policy instance | 8 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 231110 |
| Policy instance | 9 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0234440 |
| Policy instance | 15 |
| HYATT LEGAL PLANS OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 92600099 |
| Policy instance | 14 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0215132 |
| Policy instance | 13 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0165405 |
| Policy instance | 12 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35999 |
| Policy instance | 11 |
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) | |
| Policy contract number | 10470 |
| Policy instance | 10 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 68899 |
| Policy instance | 1 |
| AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 ) | |
| Policy contract number | 0727530HNO |
| Policy instance | 3 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0727530 |
| Policy instance | 4 |
| TEXAS HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16121 ) | |
| Policy contract number | 0727530TH |
| Policy instance | 5 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | R23218 |
| Policy instance | 6 |
| BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 96962 ) | |
| Policy contract number | L00733 |
| Policy instance | 7 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35999 |
| Policy instance | 8 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 603670 |
| Policy instance | 9 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 231110 |
| Policy instance | 10 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 68899 |
| Policy instance | 2 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) | |
| Policy contract number | 7236 |
| Policy instance | 16 |
| HYATT LEGAL PLANS OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 9260099 |
| Policy instance | 15 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0234440 |
| Policy instance | 14 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0215132 |
| Policy instance | 13 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0165405 |
| Policy instance | 12 |
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) | |
| Policy contract number | 10470 |
| Policy instance | 11 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 231110 |
| Policy instance | 10 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 603670 |
| Policy instance | 9 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35999 |
| Policy instance | 8 |
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |
| Policy contract number | L00733 |
| Policy instance | 7 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | R23218 |
| Policy instance | 6 |
| TEXAS HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16121 ) | |
| Policy contract number | 0727530-TH |
| Policy instance | 5 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0727530-MEDICAL |
| Policy instance | 4 |
| AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 ) | |
| Policy contract number | 0727530-HNO |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 68899 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 68899 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) | |
| Policy contract number | 10470 |
| Policy instance | 11 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0165405 |
| Policy instance | 12 |
| HYATT LEGAL PLANS OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 9260099 |
| Policy instance | 22 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) | |
| Policy contract number | 7236 |
| Policy instance | 21 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 955436 |
| Policy instance | 20 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 955435 |
| Policy instance | 19 |
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) | |
| Policy contract number | 955431 |
| Policy instance | 18 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800885 |
| Policy instance | 17 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800884 |
| Policy instance | 16 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800886 |
| Policy instance | 15 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800896 |
| Policy instance | 14 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0215132 |
| Policy instance | 13 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 231110 |
| Policy instance | 8 |
| HYATT LEGAL PLANS OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 9260099 |
| Policy instance | 17 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 68899 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800884 |
| Policy instance | 14 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800886 |
| Policy instance | 13 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 68899 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0215132 |
| Policy instance | 11 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0165405 |
| Policy instance | 10 |
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) | |
| Policy contract number | 10470 |
| Policy instance | 9 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 603670 |
| Policy instance | 7 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 35999 |
| Policy instance | 6 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | R23218 |
| Policy instance | 5 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0727530-MEDICAL |
| Policy instance | 4 |
| AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 ) | |
| Policy contract number | 0727530-HNO |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800885 |
| Policy instance | 15 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800896 |
| Policy instance | 12 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) | |
| Policy contract number | 7236 |
| Policy instance | 16 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 68899 |
| Policy instance | 19 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800884 |
| Policy instance | 11 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800885 |
| Policy instance | 12 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800886 |
| Policy instance | 13 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800896 |
| Policy instance | 14 |
| HYATT LEGAL PLANS OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 9260099 |
| Policy instance | 15 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) | |
| Policy contract number | 7236 |
| Policy instance | 16 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 98376 |
| Policy instance | 17 |
| AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 ) | |
| Policy contract number | 0727530-HNO |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 68899 |
| Policy instance | 1 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0727530-MEDICAL |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 98376 |
| Policy instance | 18 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0165405 |
| Policy instance | 8 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5343611 |
| Policy instance | 7 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0215132 |
| Policy instance | 9 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 603670 |
| Policy instance | 6 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 231110 |
| Policy instance | 5 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0215132 |
| Policy instance | 10 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | R23218 |
| Policy instance | 4 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | V0040 |
| Policy instance | 6 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 18237 |
| Policy instance | 5 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0727530-MEDICAL |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 93413 |
| Policy instance | 4 |
| AETNA HEALTH INC (National Association of Insurance Commissioners NAIC id number: 95088 ) | |
| Policy contract number | 0727530-HNO |
| Policy instance | 2 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0727530 DENTAL |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800885 |
| Policy instance | 21 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | V0365 |
| Policy instance | 7 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | V1151 |
| Policy instance | 8 |
| ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 95473 ) | |
| Policy contract number | R23218 |
| Policy instance | 9 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800896 |
| Policy instance | 22 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | CS34414 |
| Policy instance | 18 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | 68899 |
| Policy instance | 13 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800896 |
| Policy instance | 23 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800886 |
| Policy instance | 22 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800884 |
| Policy instance | 20 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) | |
| Policy contract number | 7236 |
| Policy instance | 19 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | TS05343611 |
| Policy instance | 17 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0165405 |
| Policy instance | 16 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 603670 |
| Policy instance | 15 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800886 |
| Policy instance | 21 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800885 |
| Policy instance | 20 |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |
| Policy contract number | R23218 |
| Policy instance | 10 |
| ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 ) | |
| Policy contract number | R23218 |
| Policy instance | 11 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | 68899 |
| Policy instance | 12 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 231110 |
| Policy instance | 13 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 603670 |
| Policy instance | 14 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0165405 |
| Policy instance | 15 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | TS05343611 |
| Policy instance | 16 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | CS34414 |
| Policy instance | 17 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) | |
| Policy contract number | 7236 |
| Policy instance | 18 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 800884 |
| Policy instance | 19 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 231110 |
| Policy instance | 14 |
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