401k Plan data: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN plan

WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN
Plan identification number	501

WELLMONT HEALTH SYSTEM WELFARE 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) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

WELLMONT HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: WELLMONT HEALTH SYSTEM

Employer identification number (EIN): 621636465

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about WELLMONT HEALTH SYSTEM

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1996-06-14

Company Identification Number: F125749

Legal Registered Office Address: 131 EAST VALLEY STREET

ABINGDON
United States of America (USA)
24210

More information about WELLMONT HEALTH SYSTEM

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-07-01 CYNTHIA COX 2019-06-11
501 2017-07-01 CYNTHIA COX 2019-04-12
501 2016-07-01 HAMLIN WILSON
501 2015-07-01 HAMLIN WILSON
501 2014-07-01 HAMLIN WILSON
501 2013-07-01 HAMLIN WILSON
501 2012-07-01 HAMLIN WILSON
501 2011-07-01 HAMLIN J. WILSON
501 2009-07-01 HAMLIN J. WILSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2017-07-01	CYNTHIA COX	2019-06-11
501	2017-07-01	CYNTHIA COX	2019-04-12
501	2016-07-01	HAMLIN WILSON
501	2015-07-01	HAMLIN WILSON
501	2014-07-01	HAMLIN WILSON
501	2013-07-01	HAMLIN WILSON
501	2012-07-01	HAMLIN WILSON
501	2011-07-01	HAMLIN J. WILSON
501	2009-07-01	HAMLIN J. WILSON

Plan Statistics for WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN

401k plan membership statisitcs for WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN

Measure Date Value
2017: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 6,036
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 5,990
Number of retired or separated participants receiving benefits 2017-07-01 51
Number of other retired or separated participants entitled to future benefits 2017-07-01 121
Total of all active and inactive participants 2017-07-01 6,162
2016: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 5,425
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 5,791
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 176
Total of all active and inactive participants 2016-07-01 5,967
2015: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 5,518
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 5,231
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 194
Total of all active and inactive participants 2015-07-01 5,425
2014: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 5,559
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 5,300
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 218
Total of all active and inactive participants 2014-07-01 5,518
2013: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 5,697
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 5,470
Number of retired or separated participants receiving benefits 2013-07-01 89
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 5,559
2012: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 5,467
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 5,697
Number of retired or separated participants receiving benefits 2012-07-01 96
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 5,793
2011: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 5,466
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 5,560
Number of retired or separated participants receiving benefits 2011-07-01 87
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 5,647
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 5,647
Number of participants with account balances 2011-07-01 0
2009: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 5,558
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 5,354
Number of retired or separated participants receiving benefits 2009-07-01 154
Number of other retired or separated participants entitled to future benefits 2009-07-01 1
Total of all active and inactive participants 2009-07-01 5,509
Total participants 2009-07-01 5,509

Measure	Date	Value
2017: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	6,036
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	5,990
Number of retired or separated participants receiving benefits	2017-07-01	51
Number of other retired or separated participants entitled to future benefits	2017-07-01	121
Total of all active and inactive participants	2017-07-01	6,162
2016: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	5,425
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	5,791
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	176
Total of all active and inactive participants	2016-07-01	5,967
2015: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	5,518
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	5,231
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	194
Total of all active and inactive participants	2015-07-01	5,425
2014: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	5,559
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	5,300
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	218
Total of all active and inactive participants	2014-07-01	5,518
2013: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	5,697
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	5,470
Number of retired or separated participants receiving benefits	2013-07-01	89
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	5,559
2012: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	5,467
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	5,697
Number of retired or separated participants receiving benefits	2012-07-01	96
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	5,793
2011: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	5,466
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	5,560
Number of retired or separated participants receiving benefits	2011-07-01	87
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	5,647
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	5,647
Number of participants with account balances	2011-07-01	0
2009: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	5,558
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	5,354
Number of retired or separated participants receiving benefits	2009-07-01	154
Number of other retired or separated participants entitled to future benefits	2009-07-01	1
Total of all active and inactive participants	2009-07-01	5,509
Total participants	2009-07-01	5,509

Form 5500 Responses for WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN

2017: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	Yes
2017-07-01	This submission is the final filing	Yes
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: WELLMONT HEALTH SYSTEM WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

BRKC008NT

Policy instance

Insurance contract or identification number	BRKC008NT
Number of Individuals Covered	1611
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $43,212
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT AND CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $559,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

LBT

Policy instance

Insurance contract or identification number	LBT
Number of Individuals Covered	720
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $105,118
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	LBT
Welfare Benefit Premiums Paid to Carrier	USD $414,440
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

FLK960638

Policy instance

Insurance contract or identification number	FLK960638
Number of Individuals Covered	5860
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $98,804
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $924,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ETB111715

Policy instance

Insurance contract or identification number	ETB111715
Number of Individuals Covered	500
Insurance policy start date	2017-07-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $1,440
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL
Welfare Benefit Premiums Paid to Carrier	USD $9,600
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

VDT961164

Policy instance

Insurance contract or identification number	VDT961164
Number of Individuals Covered	3124
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $53,301
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,032,289
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

OK966305

Policy instance

Insurance contract or identification number	OK966305
Number of Individuals Covered	5860
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $9,433
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $103,849
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

FLX964717

Policy instance

Insurance contract or identification number	FLX964717
Number of Individuals Covered	5860
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $113,782
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,818,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ETB111715

Policy instance

Insurance contract or identification number	ETB111715
Number of Individuals Covered	500
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,440
Other welfare benefits provided	OTHER - BUSINESS TRAVEL
Welfare Benefit Premiums Paid to Carrier	USD $9,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,440
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	NASH & POWERS INSURANCE CO

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

Policy contract number

FLK960638

Policy instance

Insurance contract or identification number	FLK960638
Number of Individuals Covered	5231
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $108,644
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $825,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108,644
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN

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

Policy contract number

FLX964717

Policy instance

Insurance contract or identification number	FLX964717
Number of Individuals Covered	5375
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $122,984
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,548,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $122,984
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

OK 966305

Policy instance

Insurance contract or identification number	OK 966305
Number of Individuals Covered	5231
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $9,251
Other welfare benefits provided	OTHER - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $84,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,251
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

VDT961164

Policy instance

Insurance contract or identification number	VDT961164
Number of Individuals Covered	2869
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $53,644
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $851,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,644
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

H2001

Policy instance

Insurance contract or identification number	H2001
Number of Individuals Covered	180
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Other welfare benefits provided	OTHER - RETIREE HEALTH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

H2001

Policy instance

Insurance contract or identification number	H2001
Number of Individuals Covered	194
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Other welfare benefits provided	OTHER - RETIREE HEALTH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ETB111715

Policy instance

Insurance contract or identification number	ETB111715
Number of Individuals Covered	500
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $1,440
Other welfare benefits provided	OTHER - BUSINESS TRAVEL
Welfare Benefit Premiums Paid to Carrier	USD $9,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,440
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	NASH & POWERS INSURANCE CO

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

Policy contract number

VDT961164

Policy instance

Insurance contract or identification number	VDT961164
Number of Individuals Covered	3025
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $65,257
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $891,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,257
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

OK 966305

Policy instance

Insurance contract or identification number	OK 966305
Number of Individuals Covered	5300
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $14,305
Other welfare benefits provided	OTHER - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $86,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,305
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

FLX964717

Policy instance

Insurance contract or identification number	FLX964717
Number of Individuals Covered	5453
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $184,970
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,531,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $184,970
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

FLK960638

Policy instance

Insurance contract or identification number	FLK960638
Number of Individuals Covered	5300
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $169,419
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $847,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $169,419
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN

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

Policy contract number

FLK960638

Policy instance

Insurance contract or identification number	FLK960638
Number of Individuals Covered	5320
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $24,164
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $865,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,164
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN

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

Policy contract number

ETB111715

Policy instance

Insurance contract or identification number	ETB111715
Number of Individuals Covered	500
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $1,440
Other welfare benefits provided	OTHER - BUSINESS TRAVEL
Welfare Benefit Premiums Paid to Carrier	USD $9,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,440
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	NASH & POWERS INSURANCE CO

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

Policy contract number

FLX964717

Policy instance

Insurance contract or identification number	FLX964717
Number of Individuals Covered	5470
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $43,017
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,533,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,017
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

OK 966305

Policy instance

Insurance contract or identification number	OK 966305
Number of Individuals Covered	5302
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,452
Other welfare benefits provided	OTHER - AD&D
Welfare Benefit Premiums Paid to Carrier	USD $87,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,452
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

VDT961164

Policy instance

Insurance contract or identification number	VDT961164
Number of Individuals Covered	3168
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $49,093
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $915,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,093
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	219
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Other welfare benefits provided	OTHER - RETIREE HEALTH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ETB111715

Policy instance

Insurance contract or identification number	ETB111715
Number of Individuals Covered	500
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $1,440
Welfare Benefit Premiums Paid to Carrier	USD $9,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,440
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	NASH & POWERS INSURANCE CO

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

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	247
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
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

VDT961164

Policy instance

Insurance contract or identification number	VDT961164
Number of Individuals Covered	3525
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $40,586
Welfare Benefit Premiums Paid to Carrier	USD $861,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,586
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

OK 966305

Policy instance

Insurance contract or identification number	OK 966305
Number of Individuals Covered	5515
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $4,655
Welfare Benefit Premiums Paid to Carrier	USD $93,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,655
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

FLK960638

Policy instance

Insurance contract or identification number	FLK960638
Number of Individuals Covered	5539
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $39,105
Welfare Benefit Premiums Paid to Carrier	USD $821,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,105
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN

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

Policy contract number

FLX964717

Policy instance

Insurance contract or identification number	FLX964717
Number of Individuals Covered	5793
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $81,862
Welfare Benefit Premiums Paid to Carrier	USD $1,648,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,862
Additional information about fees paid to insurance broker	SALES & SERVICE SUPP. COMMISSION
Insurance broker organization code?	7
Insurance broker name	MARSH & MCLENNAN AGENCY

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

Policy contract number

OK 966305

Policy instance

Insurance contract or identification number	OK 966305
Number of Individuals Covered	5373
Insurance policy start date	2012-05-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $60
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

H1509

Policy instance

Insurance contract or identification number	H1509
Number of Individuals Covered	275
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ETB111715

Policy instance

Insurance contract or identification number	ETB111715
Number of Individuals Covered	500
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $1,440
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $9,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD 0754F

Policy instance

Insurance contract or identification number	GUD 0754F
Number of Individuals Covered	5390
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $97,431
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,217,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0754F

Policy instance

Insurance contract or identification number	GUC 0754F
Number of Individuals Covered	2904
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $194,565
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,144,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG 0754F

Policy instance

Insurance contract or identification number	GLUG 0754F
Number of Individuals Covered	5560
Insurance policy start date	2011-07-01
Insurance policy end date	2012-05-01
Total amount of commissions paid to insurance broker	USD $21,356
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $213,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL 0754F

Policy instance

Insurance contract or identification number	GVTL 0754F
Number of Individuals Covered	2624
Insurance policy start date	2011-07-01
Insurance policy end date	2012-05-01
Total amount of commissions paid to insurance broker	USD $172,988
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,153,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

68010

Policy instance

Insurance contract or identification number	68010
Number of Individuals Covered	289
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $99,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ETB111715

Policy instance

Insurance contract or identification number	ETB111715
Number of Individuals Covered	500
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $1,440
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $9,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD 0754F

Policy instance

Insurance contract or identification number	GUD 0754F
Number of Individuals Covered	5088
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $95,526
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,194,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL 0754F

Policy instance

Insurance contract or identification number	GVTL 0754F
Number of Individuals Covered	2641
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $194,650
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,297,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG 0754F

Policy instance

Insurance contract or identification number	GLUG 0754F
Number of Individuals Covered	5331
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $25,182
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $251,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC 0754F

Policy instance

Insurance contract or identification number	GUC 0754F
Number of Individuals Covered	2906
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $191,474
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,126,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

WELLMONT HEALTH SYSTEM 401(K) RETIREMENT SAVINGS PLAN [EIN = 621567353]

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Company Name:	WELLMONT HEALTH SYSTEM
Employer identification number (EIN):	621636465
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1996-06-14
Company Identification Number:	F125749
Legal Registered Office Address:	131 EAST VALLEY STREET ABINGDON United States of America (USA) 24210