401k Plan data: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN plan

NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number	510

NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

NORTON HEALTHCARE, INC. DEPARTMENT has sponsored the creation of one or more 401k plans.

Company Name: NORTON HEALTHCARE, INC. DEPARTMENT

Employer identification number (EIN): 611028725

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about NORTON HEALTHCARE, INC. DEPARTMENT

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2020-08-06

Company Identification Number: 604644169

Legal Registered Office Address: 18928 13TH AVE SE

BOTHELL
United States of America (USA)
980126864

More information about NORTON HEALTHCARE, INC. DEPARTMENT

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2022-01-01
510 2021-01-01
510 2020-01-01
510 2019-01-01
510 2018-01-01
510 2017-01-01 JOHN HAMMOND
510 2017-01-01 JOHN HAMMOND
510 2016-01-01 JOHN HAMMOND
510 2015-01-01 JOHN HAMMOND
510 2014-01-01 JOHN HAMMOND
510 2013-01-01 JOHN HAMMOND
510 2012-01-01 JOHN HAMMOND

Plan Statistics for NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2022: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 15,041
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 15,076
Number of retired or separated participants receiving benefits 2022-01-01 123
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 15,199
2021: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 14,958
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 14,897
Number of retired or separated participants receiving benefits 2021-01-01 144
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 15,041
2020: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 13,481
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 14,823
Number of retired or separated participants receiving benefits 2020-01-01 135
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 14,958
2019: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 12,929
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 13,375
Number of retired or separated participants receiving benefits 2019-01-01 115
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 13,490
2018: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 12,768
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 12,847
Number of retired or separated participants receiving benefits 2018-01-01 97
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 12,944
2017: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 12,280
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 12,696
Number of retired or separated participants receiving benefits 2017-01-01 73
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 12,769
2016: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 11,604
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 12,206
Number of retired or separated participants receiving benefits 2016-01-01 74
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 12,280
2015: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 10,828
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 11,604
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 11,604
2014: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 10,455
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 10,828
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 10,828
2013: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 11,957
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 10,455
Total of all active and inactive participants 2013-01-01 10,455
2012: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 11,569
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 11,957
Total of all active and inactive participants 2012-01-01 11,957

Measure	Date	Value
2022: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	15,041
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	15,076
Number of retired or separated participants receiving benefits	2022-01-01	123
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	15,199
2021: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	14,958
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	14,897
Number of retired or separated participants receiving benefits	2021-01-01	144
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	15,041
2020: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	13,481
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	14,823
Number of retired or separated participants receiving benefits	2020-01-01	135
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	14,958
2019: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	12,929
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	13,375
Number of retired or separated participants receiving benefits	2019-01-01	115
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	13,490
2018: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	12,768
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	12,847
Number of retired or separated participants receiving benefits	2018-01-01	97
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	12,944
2017: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	12,280
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	12,696
Number of retired or separated participants receiving benefits	2017-01-01	73
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	12,769
2016: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	11,604
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	12,206
Number of retired or separated participants receiving benefits	2016-01-01	74
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	12,280
2015: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	10,828
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	11,604
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	11,604
2014: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	10,455
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	10,828
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	10,828
2013: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	11,957
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	10,455
Total of all active and inactive participants	2013-01-01	10,455
2012: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	11,569
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	11,957
Total of all active and inactive participants	2012-01-01	11,957

Form 5500 Responses for NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN

2022: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT 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: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
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: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT 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: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT 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: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT 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: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT 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: NORTON HEALTHCARE, INC. EMPLOYEE HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000021923

Policy instance

Insurance contract or identification number	0000021923
Number of Individuals Covered	10
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $118
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $1,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59
Insurance broker organization code?	3

CENTRAL UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61883 )

Policy contract number

897552

Policy instance

Insurance contract or identification number	897552
Number of Individuals Covered	25
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,440
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS/CANCER
Welfare Benefit Premiums Paid to Carrier	USD $7,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $854
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

004009963

Policy instance

Insurance contract or identification number	004009963
Number of Individuals Covered	26216
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Welfare Benefit Premiums Paid to Carrier	USD $877,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	515
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $66,881
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $312,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,881
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0101

Policy instance

Insurance contract or identification number	604657 0101
Number of Individuals Covered	15076
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $134,746
Total amount of fees paid to insurance company	USD $251,869
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,137,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	251869
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $100,607

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7390001

Policy instance

Insurance contract or identification number	7390001
Number of Individuals Covered	399
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $100,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0707160

Policy instance

Insurance contract or identification number	0707160
Number of Individuals Covered	27289
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000159212

Policy instance

Insurance contract or identification number	0000159212
Number of Individuals Covered	106
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,027
Total amount of fees paid to insurance company	USD $3,818
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,027
Amount paid for insurance broker fees	3818
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701635

Policy instance

Insurance contract or identification number	701635
Number of Individuals Covered	12285
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $178,772
Total amount of fees paid to insurance company	USD $256,391
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,133,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	256391
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $178,772

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

54190

Policy instance

Insurance contract or identification number	54190
Number of Individuals Covered	7247
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $499,046
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,470,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $249,523
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70572-1

Policy instance

Insurance contract or identification number	70572-1
Number of Individuals Covered	21977
Insurance policy start date	2021-08-01
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $1,273,408
Total amount of fees paid to insurance company	USD $120,000
Other welfare benefits provided	ACCIDENT, CI, HOSPITAL CONFINEMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,914,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $636,704
Amount paid for insurance broker fees	120000
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Y4B

Policy instance

Insurance contract or identification number	Y4B
Number of Individuals Covered	23685
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,353,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0102

Policy instance

Insurance contract or identification number	604657 0102
Number of Individuals Covered	6046
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $361,756
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,070,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $269,634
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0103

Policy instance

Insurance contract or identification number	604657 0103
Number of Individuals Covered	24910
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $115,810
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,860,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $115,810
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

55237

Policy instance

Insurance contract or identification number	55237
Number of Individuals Covered	2475
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $392,092
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $785,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $196,046
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000164718

Policy instance

Insurance contract or identification number	0000164718
Number of Individuals Covered	80
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $40,245
Total amount of fees paid to insurance company	USD $11,961
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $218,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,245
Amount paid for insurance broker fees	11961
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0707160

Policy instance

Insurance contract or identification number	0707160
Number of Individuals Covered	26973
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7390001

Policy instance

Insurance contract or identification number	7390001
Number of Individuals Covered	354
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $83,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0101

Policy instance

Insurance contract or identification number	604657 0101
Number of Individuals Covered	14897
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $102,019
Total amount of fees paid to insurance company	USD $75,142
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,394,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $102,019
Insurance broker organization code?	3
Amount paid for insurance broker fees	75142
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	517
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $57,105
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $278,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,105
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

004009963

Policy instance

Insurance contract or identification number	004009963
Number of Individuals Covered	26024
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Welfare Benefit Premiums Paid to Carrier	USD $987,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000164718

Policy instance

Insurance contract or identification number	0000164718
Number of Individuals Covered	80
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $36,431
Total amount of fees paid to insurance company	USD $3,542
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $207,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,431
Amount paid for insurance broker fees	3542
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000159212

Policy instance

Insurance contract or identification number	0000159212
Number of Individuals Covered	107
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,900
Total amount of fees paid to insurance company	USD $8,304
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,900
Amount paid for insurance broker fees	8304
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701635

Policy instance

Insurance contract or identification number	701635
Number of Individuals Covered	12273
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $173,753
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,492,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $173,753
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000021923

Policy instance

Insurance contract or identification number	0000021923
Number of Individuals Covered	7488
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $120
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $2,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

55237

Policy instance

Insurance contract or identification number	55237
Number of Individuals Covered	2350
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $541,114
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $659,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $270,557
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0103

Policy instance

Insurance contract or identification number	604657 0103
Number of Individuals Covered	24417
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of fees paid to insurance company	USD $235,444
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,417,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	235444
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0102

Policy instance

Insurance contract or identification number	604657 0102
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $266,901
Total amount of fees paid to insurance company	USD $190,359
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,635,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $266,901
Insurance broker organization code?	3
Amount paid for insurance broker fees	190359
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Y4B

Policy instance

Insurance contract or identification number	Y4B
Number of Individuals Covered	23369
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,150,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70572-1

Policy instance

Insurance contract or identification number	70572-1
Number of Individuals Covered	26094
Insurance policy start date	2020-08-01
Insurance policy end date	2021-07-31
Total amount of commissions paid to insurance broker	USD $1,371,010
Other welfare benefits provided	ACCIDENT, CI, HOSPITAL CONFINEMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,366,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $745,505
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

54190

Policy instance

Insurance contract or identification number	54190
Number of Individuals Covered	7322
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $455,104
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,929,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $227,552
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0707160

Policy instance

Insurance contract or identification number	0707160
Number of Individuals Covered	26772
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7390001

Policy instance

Insurance contract or identification number	7390001
Number of Individuals Covered	319
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $73,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0101

Policy instance

Insurance contract or identification number	604657 0101
Number of Individuals Covered	14823
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $119,144
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,489,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $119,144
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000021923

Policy instance

Insurance contract or identification number	0000021923
Number of Individuals Covered	7488
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $120
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $2,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	506
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $66,991
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $302,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,991
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

004009963

Policy instance

Insurance contract or identification number	004009963
Number of Individuals Covered	26031
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Welfare Benefit Premiums Paid to Carrier	USD $960,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000159212

Policy instance

Insurance contract or identification number	0000159212
Number of Individuals Covered	103
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $17,807
Total amount of fees paid to insurance company	USD $9,437
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,807
Amount paid for insurance broker fees	9437
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701635

Policy instance

Insurance contract or identification number	701635
Number of Individuals Covered	12027
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $419,802
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,883,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $222,139
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

55237

Policy instance

Insurance contract or identification number	55237
Number of Individuals Covered	755
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $57,586
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,793
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0103

Policy instance

Insurance contract or identification number	604657 0103
Number of Individuals Covered	23664
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,624,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0102

Policy instance

Insurance contract or identification number	604657 0102
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $334,232
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,177,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $334,232
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Y4B

Policy instance

Insurance contract or identification number	Y4B
Number of Individuals Covered	22954
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,098,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70572-1

Policy instance

Insurance contract or identification number	70572-1
Number of Individuals Covered	21157
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
Total amount of commissions paid to insurance broker	USD $1,937,110
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,367,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,028,020
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

54190

Policy instance

Insurance contract or identification number	54190
Number of Individuals Covered	7414
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $760,126
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,482,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $380,063
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000021923

Policy instance

Insurance contract or identification number	0000021923
Number of Individuals Covered	7488
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $61,910
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $524,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,955
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0103

Policy instance

Insurance contract or identification number	604657 0103
Number of Individuals Covered	21480
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,078,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0102

Policy instance

Insurance contract or identification number	604657 0102
Number of Individuals Covered	6285
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $236,130
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,951,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $236,130
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Y4B

Policy instance

Insurance contract or identification number	Y4B
Number of Individuals Covered	20827
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $984,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

70572-1

Policy instance

Insurance contract or identification number	70572-1
Number of Individuals Covered	14540
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $1,331,358
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,860,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $690,679
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

54190

Policy instance

Insurance contract or identification number	54190
Number of Individuals Covered	7333
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,694,350
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,340,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $847,175
Insurance broker organization code?	3

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL30356

Policy instance

Insurance contract or identification number	HCL30356
Number of Individuals Covered	10863
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $44,303
Welfare Benefit Premiums Paid to Carrier	USD $886,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,303
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	490
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $50,670
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $282,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,670
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657 0101

Policy instance

Insurance contract or identification number	604657 0101
Number of Individuals Covered	13375
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $75,728
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $946,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75,728
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7390001

Policy instance

Insurance contract or identification number	7390001
Number of Individuals Covered	272
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $59,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0009185706

Policy instance

Insurance contract or identification number	0009185706
Number of Individuals Covered	5254
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $114,458
Total amount of fees paid to insurance company	USD $15,498
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $714,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,609
Amount paid for insurance broker fees	7819
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701635

Policy instance

Insurance contract or identification number	701635
Number of Individuals Covered	10995
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $208,443
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,163,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $123,280
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000159212

Policy instance

Insurance contract or identification number	0000159212
Number of Individuals Covered	104
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $15,643
Total amount of fees paid to insurance company	USD $6,467
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,643
Amount paid for insurance broker fees	6467
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0707160

Policy instance

Insurance contract or identification number	0707160
Number of Individuals Covered	24547
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000021923

Policy instance

Insurance contract or identification number	0000021923
Number of Individuals Covered	7373
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $117,268
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $817,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,634
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657

Policy instance

Insurance contract or identification number	604657
Number of Individuals Covered	12847
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $368,981
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,897,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $368,981
Insurance broker organization code?	3

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL30356

Policy instance

Insurance contract or identification number	HCL30356
Number of Individuals Covered	10465
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $55,649
Welfare Benefit Premiums Paid to Carrier	USD $1,112,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,649
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	440
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $64,774
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $294,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,774
Insurance broker organization code?	3

CENTRAL UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61883 )

Policy contract number

897552

Policy instance

Insurance contract or identification number	897552
Number of Individuals Covered	33
Insurance policy start date	2018-07-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $54,834
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL ILLNESS / CANCER
Welfare Benefit Premiums Paid to Carrier	USD $306,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,026
Insurance broker organization code?	3

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

897552

Policy instance

Insurance contract or identification number	897552
Number of Individuals Covered	7116
Insurance policy start date	2018-01-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $574,187
Total amount of fees paid to insurance company	USD $73,804
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,958,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $305,411
Amount paid for insurance broker fees	37676
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7390001

Policy instance

Insurance contract or identification number	7390001
Number of Individuals Covered	57
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $13,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0707160

Policy instance

Insurance contract or identification number	0707160
Number of Individuals Covered	23515
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0009185706

Policy instance

Insurance contract or identification number	0009185706
Number of Individuals Covered	5599
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $238,745
Total amount of fees paid to insurance company	USD $28,330
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,291,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $120,068
Amount paid for insurance broker fees	14551
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000159212

Policy instance

Insurance contract or identification number	0000159212
Number of Individuals Covered	102
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $18,636
Total amount of fees paid to insurance company	USD $18,235
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,636
Amount paid for insurance broker fees	18235
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

701635

Policy instance

Insurance contract or identification number	701635
Number of Individuals Covered	10434
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $138,935
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,946,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $138,935
Insurance broker organization code?	3

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

54190

Policy instance

Insurance contract or identification number	54190
Number of Individuals Covered	5684
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $419,358
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $466,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $209,679
Insurance broker organization code?	3

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL30356

Policy instance

Insurance contract or identification number	HCL30356
Number of Individuals Covered	10337
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $42,087
Welfare Benefit Premiums Paid to Carrier	USD $1,052,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,087
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	296
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $54,082
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $300,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,082
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657

Policy instance

Insurance contract or identification number	604657
Number of Individuals Covered	12757
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $288,112
Total amount of fees paid to insurance company	USD $129,561
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,478,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $288,112
Amount paid for insurance broker fees	129561
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

897552

Policy instance

Insurance contract or identification number	897552
Number of Individuals Covered	7748
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $965,747
Total amount of fees paid to insurance company	USD $173,212
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $3,481,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $494,705
Amount paid for insurance broker fees	86606
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	MEDLINK INC

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000021923

Policy instance

Insurance contract or identification number	0000021923
Number of Individuals Covered	5829
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $124,354
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $651,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,177
Insurance broker organization code?	3
Insurance broker name	BCINSOURCING LLC

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7390001

Policy instance

Insurance contract or identification number	7390001
Number of Individuals Covered	58
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $14,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0009185706

Policy instance

Insurance contract or identification number	0009185706
Number of Individuals Covered	5515
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $254,356
Total amount of fees paid to insurance company	USD $22,246
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,180,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $126,948
Amount paid for insurance broker fees	12535
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504478

Policy instance

Insurance contract or identification number	00504478
Number of Individuals Covered	10126
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,926,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000159212

Policy instance

Insurance contract or identification number	0000159212
Number of Individuals Covered	99
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $17,160
Total amount of fees paid to insurance company	USD $4,268
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $103,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,160
Amount paid for insurance broker fees	4268
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

21923

Policy instance

Insurance contract or identification number	21923
Number of Individuals Covered	516
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,056
Other welfare benefits provided	HOSPITAL INDEMNITY
Welfare Benefit Premiums Paid to Carrier	USD $3,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $528
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

691054

Policy instance

Insurance contract or identification number	691054
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL30356

Policy instance

Insurance contract or identification number	HCL30356
Number of Individuals Covered	9375
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $31,438
Welfare Benefit Premiums Paid to Carrier	USD $785,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,438
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	476
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $59,201
Total amount of fees paid to insurance company	USD $5,920
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $288,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,201
Amount paid for insurance broker fees	5920
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657

Policy instance

Insurance contract or identification number	604657
Number of Individuals Covered	27993
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $290,010
Total amount of fees paid to insurance company	USD $138,965
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $5,795,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $290,010
Amount paid for insurance broker fees	138965
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

7210261000

Policy instance

Insurance contract or identification number	7210261000
Insurance policy start date	2015-01-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $236,553
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $525,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $118,842
Insurance broker organization code?	3
Insurance broker name	ANDERSON, DAVID O

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

897552

Policy instance

Insurance contract or identification number	897552
Number of Individuals Covered	6790
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $578,656
Total amount of fees paid to insurance company	USD $3,345
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	SUPPLEMENTAL CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,081,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $289,597
Amount paid for insurance broker fees	2937
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	EPIC INSURANCE SOLUTIONS LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00504478

Policy instance

Insurance contract or identification number	00504478
Number of Individuals Covered	9238
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,185,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7390001

Policy instance

Insurance contract or identification number	7390001
Number of Individuals Covered	70
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $13,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

9185706

Policy instance

Insurance contract or identification number	9185706
Number of Individuals Covered	4563
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $276,438
Total amount of fees paid to insurance company	USD $40,236
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $892,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $138,219
Amount paid for insurance broker fees	20118
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HEALTH AND BENEFIT SYSTEMS INC.

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL30356

Policy instance

Insurance contract or identification number	HCL30356
Number of Individuals Covered	9126
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $26,823
Welfare Benefit Premiums Paid to Carrier	USD $670,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,823
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

144939

Policy instance

Insurance contract or identification number	144939
Number of Individuals Covered	477
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $57,898
Total amount of fees paid to insurance company	USD $5,790
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $289,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,898
Amount paid for insurance broker fees	5790
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657-0101

Policy instance

Insurance contract or identification number	604657-0101
Number of Individuals Covered	10828
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $37,647
Total amount of fees paid to insurance company	USD $23,862
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $522,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,647
Amount paid for insurance broker fees	23862
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657-0102

Policy instance

Insurance contract or identification number	604657-0102
Number of Individuals Covered	6053
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $188,717
Total amount of fees paid to insurance company	USD $118,358
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,578,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $188,717
Amount paid for insurance broker fees	118358
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

604657-0103

Policy instance

Insurance contract or identification number	604657-0103
Number of Individuals Covered	10758
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $106,391
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,325,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $106,391
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 )

Policy contract number

691054

Policy instance

Insurance contract or identification number	691054
Number of Individuals Covered	8999
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0121394

Policy instance

Insurance contract or identification number	0121394
Number of Individuals Covered	20253
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $181,429
Total amount of fees paid to insurance company	USD $34,018
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,180,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $181,429
Amount paid for insurance broker fees	34018
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 )

Policy contract number

691054

Policy instance

Insurance contract or identification number	691054
Number of Individuals Covered	7824
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $811
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $811
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )

Policy contract number

304498

Policy instance

Insurance contract or identification number	304498
Number of Individuals Covered	956
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Welfare Benefit Premiums Paid to Carrier	USD $385,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

304497

Policy instance

Insurance contract or identification number	304497
Number of Individuals Covered	4
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,270
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

FLK960216

Policy instance

Insurance contract or identification number	FLK960216
Number of Individuals Covered	10338
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,817,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL30356

Policy instance

Insurance contract or identification number	HCL30356
Number of Individuals Covered	8863
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $24,208
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $605,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,208
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12081629

Policy instance

Insurance contract or identification number	12081629
Number of Individuals Covered	7242
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Vision Insurance Welfare Benefit	Yes
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

FLK960216

Policy instance

Insurance contract or identification number	FLK960216
Number of Individuals Covered	10522
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $59,181
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,801,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	59181
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

215851

Policy instance

Insurance contract or identification number	215851
Number of Individuals Covered	9022
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Welfare Benefit Premiums Paid to Carrier	USD $607,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )

Policy contract number

304497

Policy instance

Insurance contract or identification number	304497
Number of Individuals Covered	2
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )

Policy contract number

304498

Policy instance

Insurance contract or identification number	304498
Number of Individuals Covered	988
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $343,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 54739 )

Policy contract number

691054

Policy instance

Insurance contract or identification number	691054
Number of Individuals Covered	7962
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $27
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27
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

0121394

Policy instance

Insurance contract or identification number	0121394
Number of Individuals Covered	20636
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $36
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,054,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	36
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12081629

Policy instance

Insurance contract or identification number	12081629
Number of Individuals Covered	7503
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Vision 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:	NORTON HEALTHCARE, INC. DEPARTMENT
Employer identification number (EIN):	611028725
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2020-08-06
Company Identification Number:	604644169
Legal Registered Office Address:	18928 13TH AVE SE BOTHELL United States of America (USA) 980126864