BMO HARRIS BANK N.A. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS
401k plan membership statisitcs for EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS
| Measure | Date | Value |
|---|
| 2016 : EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-12-31 | $176,945,693 |
| Total of all expenses incurred | 2016-12-31 | $161,825,331 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $152,108,688 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $171,548,749 |
| Value of total assets at end of year | 2016-12-31 | $99,621,965 |
| Value of total assets at beginning of year | 2016-12-31 | $84,501,603 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $9,716,643 |
| Total interest from all sources | 2016-12-31 | $57,274 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $1,659,046 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-12-31 | $1,659,046 |
| Administrative expenses professional fees incurred | 2016-12-31 | $501,349 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $300,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $60,963,047 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $66,451 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $76,012 |
| Administrative expenses (other) incurred | 2016-12-31 | $833,361 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $15,120,362 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $99,621,965 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $84,501,603 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-12-31 | $99,555,514 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-12-31 | $84,425,591 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $57,274 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $41,457,565 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-12-31 | $3,680,624 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $110,585,702 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $110,651,123 |
| Contract administrator fees | 2016-12-31 | $8,381,933 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-12-31 | No |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | GEORGE JOHNSON & COMPANY OF IL, LLC |
| Accountancy firm EIN | 2016-12-31 | 270475249 |
| 2015 : EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-12-31 | $177,146,302 |
| Total of all expenses incurred | 2015-12-31 | $178,271,030 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $168,900,929 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $176,324,548 |
| Value of total assets at end of year | 2015-12-31 | $84,501,603 |
| Value of total assets at beginning of year | 2015-12-31 | $85,626,331 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $9,370,101 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $1,738,625 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-12-31 | $1,738,625 |
| Administrative expenses professional fees incurred | 2015-12-31 | $545,189 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $300,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $63,105,889 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $76,012 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $68,010 |
| Administrative expenses (other) incurred | 2015-12-31 | $982,735 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-1,124,728 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $84,501,603 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $85,626,331 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $84,425,591 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $85,558,321 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $43,457,088 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-12-31 | $-916,871 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $113,218,659 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $125,443,841 |
| Contract administrator fees | 2015-12-31 | $7,842,177 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-12-31 | No |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | GEORGE JOHNSON & COMPANY OF IL, LLC |
| Accountancy firm EIN | 2015-12-31 | 270475249 |
| 2014 : EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-12-31 | $176,555,608 |
| Total of all expenses incurred | 2014-12-31 | $175,860,220 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $166,028,690 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $170,489,722 |
| Value of total assets at end of year | 2014-12-31 | $85,626,331 |
| Value of total assets at beginning of year | 2014-12-31 | $84,930,943 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $9,831,530 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $1,547,571 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-12-31 | $1,547,571 |
| Administrative expenses professional fees incurred | 2014-12-31 | $312,576 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $300,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $61,505,561 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $68,010 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $70,145 |
| Administrative expenses (other) incurred | 2014-12-31 | $1,488,123 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $695,388 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $85,626,331 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $84,930,943 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $85,558,321 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $84,860,798 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $40,777,069 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-12-31 | $4,518,315 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $108,984,161 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $125,251,621 |
| Contract administrator fees | 2014-12-31 | $8,030,831 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-12-31 | No |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | GEORGE JOHNSON & COMPANY OF IL, LLC |
| Accountancy firm EIN | 2014-12-31 | 270475249 |
| 2013 : EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-12-31 | $177,140,901 |
| Total of all expenses incurred | 2013-12-31 | $171,736,234 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $163,388,331 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $167,211,217 |
| Value of total assets at end of year | 2013-12-31 | $84,930,943 |
| Value of total assets at beginning of year | 2013-12-31 | $79,526,276 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $8,347,903 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $1,458,338 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-12-31 | $1,458,338 |
| Administrative expenses professional fees incurred | 2013-12-31 | $286,428 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $300,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $63,680,075 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $70,145 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $61,465 |
| Administrative expenses (other) incurred | 2013-12-31 | $1,009,543 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $5,404,667 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $84,930,943 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $79,526,276 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-12-31 | $84,860,798 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-12-31 | $79,464,811 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $39,503,251 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-12-31 | $8,471,346 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $103,531,142 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $123,885,080 |
| Contract administrator fees | 2013-12-31 | $7,051,932 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-12-31 | No |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | GEORGE JOHNSON & COMPANY OF IL, LLC |
| Accountancy firm EIN | 2013-12-31 | 270475249 |
| 2012 : EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-12-31 | $167,042,310 |
| Total of all expenses incurred | 2012-12-31 | $168,198,028 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $160,065,459 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $160,739,771 |
| Value of total assets at end of year | 2012-12-31 | $79,526,276 |
| Value of total assets at beginning of year | 2012-12-31 | $80,681,994 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $8,132,569 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $1,616,439 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-12-31 | $1,616,439 |
| Administrative expenses professional fees incurred | 2012-12-31 | $1,016,008 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $53,560,083 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $61,465 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $71,031,174 |
| Administrative expenses (other) incurred | 2012-12-31 | $710,244 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-1,155,718 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $79,526,276 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $80,681,994 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-12-31 | $79,464,811 |
| Value of interest in common/collective trusts at beginning of year | 2012-12-31 | $7,761,478 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $1,889,342 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $1,889,342 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $51,591,637 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-12-31 | $4,686,100 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $107,179,688 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $108,473,822 |
| Contract administrator fees | 2012-12-31 | $6,406,317 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | GEORGE JOHNSON & COMPANY OF IL, LLC |
| Accountancy firm EIN | 2012-12-31 | 270475249 |
| 2011 : EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS 2011 401k financial data |
|---|
| Total transfer of assets to this plan | 2011-12-31 | $71,031,168 |
| Total income from all sources (including contributions) | 2011-12-31 | $80,479,733 |
| Total of all expenses incurred | 2011-12-31 | $83,060,193 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $79,895,247 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $80,476,377 |
| Value of total assets at end of year | 2011-12-31 | $80,681,994 |
| Value of total assets at beginning of year | 2011-12-31 | $12,231,286 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $3,164,946 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $415,492 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $31,926,917 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $71,031,174 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $756 |
| Administrative expenses (other) incurred | 2011-12-31 | $109,549 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-2,580,460 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $80,681,994 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $12,231,286 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2011-12-31 | $7,761,478 |
| Value of interest in common/collective trusts at beginning of year | 2011-12-31 | $7,917,008 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $1,889,342 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $4,313,522 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $4,313,522 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $25,365,987 |
| Net investment gain or loss from common/collective trusts | 2011-12-31 | $3,356 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $48,549,460 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $54,529,260 |
| Contract administrator fees | 2011-12-31 | $2,639,905 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | GEORGE JOHNSON & COMPANY OF IL, LLC |
| Accountancy firm EIN | 2011-12-31 | 250475249 |
| 2010 : EMPLOYEE BENEFIT PROGRAM OF BANK OF MONTREAL/HARRIS 2010 401k financial data |
|---|
| Total income from all sources (including contributions) | 2010-12-31 | $76,631,316 |
| Total of all expenses incurred | 2010-12-31 | $77,654,104 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $72,968,721 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $76,615,854 |
| Value of total assets at end of year | 2010-12-31 | $12,231,286 |
| Value of total assets at beginning of year | 2010-12-31 | $13,254,074 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $4,685,383 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Administrative expenses professional fees incurred | 2010-12-31 | $464,995 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $15,000,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $25,210,978 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $756 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $924 |
| Administrative expenses (other) incurred | 2010-12-31 | $83,951 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-1,022,788 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $12,231,286 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $13,254,074 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2010-12-31 | $7,917,008 |
| Value of interest in common/collective trusts at beginning of year | 2010-12-31 | $13,253,150 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $4,313,522 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $22,373,126 |
| Net investment gain or loss from common/collective trusts | 2010-12-31 | $15,462 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $51,404,876 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $50,595,595 |
| Contract administrator fees | 2010-12-31 | $4,136,437 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | GEORGE JOHNSON & COMPANY OF IL, LLC |
| Accountancy firm EIN | 2010-12-31 | 250475249 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 887423 |
| Policy instance | 18 |
| Insurance contract or identification number | 887423 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $138,190 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 469442-05-00020 |
| Policy instance | 9 |
| Insurance contract or identification number | 469442-05-00020 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 697953 |
| Policy instance | 1 |
| Insurance contract or identification number | 697953 | | Number of Individuals Covered | 3229 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,202,259 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 74686 |
| Policy instance | 2 |
| Insurance contract or identification number | 74686 | | Number of Individuals Covered | 11516 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $30,000 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 30000 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAM BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 87240 |
| Policy instance | 3 |
| Insurance contract or identification number | 87240 | | Number of Individuals Covered | 5129 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $691,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | BM1658 |
| Policy instance | 4 |
| Insurance contract or identification number | BM1658 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,489,482 | | 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 | 29316-4 |
| Policy instance | 5 |
| Insurance contract or identification number | 29316-4 | | Number of Individuals Covered | 32227 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $340,049 | | Total amount of fees paid to insurance company | USD $83,206 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | INDIVIDUAL EXCESS RISK | | Welfare Benefit Premiums Paid to Carrier | USD $5,545,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $194,076 | | Additional information about fees paid to insurance broker | WRITING AGENT | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 83206 | | Insurance broker name | EOI SERVICE COMPANY, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600690 |
| Policy instance | 6 |
| Insurance contract or identification number | 600690 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $260,163 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B74689/H74686 |
| Policy instance | 8 |
| Insurance contract or identification number | B74689/H74686 | | Number of Individuals Covered | 4600 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $889 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,188,716 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 605 | | Additional information about fees paid to insurance broker | MISCELLANEOUS EXPENSES | | Insurance broker organization code? | 0 | | Insurance broker name | TOWERS WATSON DELAWARE, INC. |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 180760 |
| Policy instance | 16 |
| Insurance contract or identification number | 180760 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,310 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 180750 |
| Policy instance | 17 |
| Insurance contract or identification number | 180750 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 100620 |
| Policy instance | 15 |
| Insurance contract or identification number | 100620 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $566,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 30028445 |
| Policy instance | 14 |
| Insurance contract or identification number | 30028445 | | Number of Individuals Covered | 8795 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITY HEALTH PLANS INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95796 ) |
| Policy contract number | 900017 |
| Policy instance | 13 |
| Insurance contract or identification number | 900017 | | Number of Individuals Covered | 332 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,213,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 100640 |
| Policy instance | 12 |
| Insurance contract or identification number | 100640 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN (National Association of Insurance Commissioners NAIC id number: 95311 ) |
| Policy contract number | 383 |
| Policy instance | 11 |
| Insurance contract or identification number | 383 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,047,636 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 ) |
| Policy contract number | 1034 |
| Policy instance | 10 |
| Insurance contract or identification number | 1034 | | Number of Individuals Covered | 462 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,581,902 | | 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 | 29316-4/LIFE |
| Policy instance | 5 |
| Insurance contract or identification number | 29316-4/LIFE | | Number of Individuals Covered | 36785 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $200,631 | | Total amount of fees paid to insurance company | USD $100,563 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,873,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $200,631 | | Additional information about fees paid to insurance broker | WRITING AGENT AND SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 92194 | | Insurance broker name | TOWERS WATSON DELAWARE, INC. |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | BM1658 |
| Policy instance | 4 |
| Insurance contract or identification number | BM1658 | | Number of Individuals Covered | 418 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,203,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B74689/H74686 |
| Policy instance | 8 |
| Insurance contract or identification number | B74689/H74686 | | Number of Individuals Covered | 4614 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $10,871 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,081,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 10871 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 469442 |
| Policy instance | 9 |
| Insurance contract or identification number | 469442 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $195,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 ) |
| Policy contract number | 1034 |
| Policy instance | 10 |
| Insurance contract or identification number | 1034 | | Number of Individuals Covered | 475 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,683,066 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 180760 |
| Policy instance | 16 |
| Insurance contract or identification number | 180760 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,658 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN (National Association of Insurance Commissioners NAIC id number: 95311 ) |
| Policy contract number | 383 |
| Policy instance | 11 |
| Insurance contract or identification number | 383 | | Number of Individuals Covered | 223 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $943,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 87240 |
| Policy instance | 3 |
| Insurance contract or identification number | 87240 | | Number of Individuals Covered | 5129 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $691,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 74686 |
| Policy instance | 2 |
| Insurance contract or identification number | 74686 | | Number of Individuals Covered | 12749 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $30,280 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 30280 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAMS | | Insurance broker organization code? | 3 | | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 697953 |
| Policy instance | 1 |
| Insurance contract or identification number | 697953 | | Number of Individuals Covered | 3306 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,163,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITY HEALTH PLANS INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95796 ) |
| Policy contract number | 900017 |
| Policy instance | 13 |
| Insurance contract or identification number | 900017 | | Number of Individuals Covered | 434 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,592,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 30028445 |
| Policy instance | 14 |
| Insurance contract or identification number | 30028445 | | Number of Individuals Covered | 9152 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 100620 |
| Policy instance | 15 |
| Insurance contract or identification number | 100620 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $561,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 180750 |
| Policy instance | 17 |
| Insurance contract or identification number | 180750 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,406 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600690 |
| Policy instance | 6 |
| Insurance contract or identification number | 600690 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $254,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 100640 |
| Policy instance | 12 |
| Insurance contract or identification number | 100640 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,315 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 74686 |
| Policy instance | 2 |
| Insurance contract or identification number | 74686 | | Number of Individuals Covered | 12918 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $21,988 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 21988 | | Additional information about fees paid to insurance broker | SPECIAL PROGRAM | | Insurance broker organization code? | 3 | | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 180760 |
| Policy instance | 16 |
| Insurance contract or identification number | 180760 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,290 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 697953 |
| Policy instance | 1 |
| Insurance contract or identification number | 697953 | | Number of Individuals Covered | 3455 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,196,977 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 87240 |
| Policy instance | 3 |
| Insurance contract or identification number | 87240 | | Number of Individuals Covered | 5024 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $437,707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | BM1658 |
| Policy instance | 4 |
| Insurance contract or identification number | BM1658 | | Number of Individuals Covered | 547 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,149,335 | | 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 | 29316-4/LIFE |
| Policy instance | 5 |
| Insurance contract or identification number | 29316-4/LIFE | | Number of Individuals Covered | 37020 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $230,951 | | Total amount of fees paid to insurance company | USD $87,862 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,590,404 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $230,951 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 87862 | | Additional information about fees paid to insurance broker | SERVICE FEES | | Insurance broker name | TOWERS WATSON PENNSYLVANIA, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600690 |
| Policy instance | 6 |
| Insurance contract or identification number | 600690 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $197,484 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B74689/H74686 |
| Policy instance | 8 |
| Insurance contract or identification number | B74689/H74686 | | Number of Individuals Covered | 4494 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,646,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 469442 |
| Policy instance | 9 |
| Insurance contract or identification number | 469442 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $176,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 ) |
| Policy contract number | 1034 |
| Policy instance | 10 |
| Insurance contract or identification number | 1034 | | Number of Individuals Covered | 519 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,691,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN (National Association of Insurance Commissioners NAIC id number: 95311 ) |
| Policy contract number | 383 |
| Policy instance | 11 |
| Insurance contract or identification number | 383 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $846,813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 100620 |
| Policy instance | 12 |
| Insurance contract or identification number | 100620 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $614,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITY HEALTH PLANS INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 95796 ) |
| Policy contract number | 900017 |
| Policy instance | 13 |
| Insurance contract or identification number | 900017 | | Number of Individuals Covered | 492 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,417,203 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 30028445 |
| Policy instance | 14 |
| Insurance contract or identification number | 30028445 | | Number of Individuals Covered | 8659 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MERCYCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60215 ) |
| Policy contract number | 100640 |
| Policy instance | 15 |
| Insurance contract or identification number | 100640 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 74686 |
| Policy instance | 2 |
| Insurance contract or identification number | 74686 | | Number of Individuals Covered | 12849 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $16,547 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 16547 | | Additional information about fees paid to insurance broker | SERVICE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | TOWERS PERRIN FORSTER & CROSBY |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 87240 |
| Policy instance | 3 |
| Insurance contract or identification number | 87240 | | Number of Individuals Covered | 5049 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $453,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | BM1658 |
| Policy instance | 4 |
| Insurance contract or identification number | BM1658 | | Number of Individuals Covered | 592 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,869,611 | | 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 | 29316-4/LIFE |
| Policy instance | 5 |
| Insurance contract or identification number | 29316-4/LIFE | | Number of Individuals Covered | 24247 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $187,273 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,745,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $187,273 | | Additional information about fees paid to insurance broker | WRITING AGENT | | Insurance broker organization code? | 3 | | Insurance broker name | EOI SERVICE COMPANY, INC. |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600690 |
| Policy instance | 6 |
| Insurance contract or identification number | 600690 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $187,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B74689/H74686 |
| Policy instance | 8 |
| Insurance contract or identification number | B74689/H74686 | | Number of Individuals Covered | 4590 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,737,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 469442 |
| Policy instance | 9 |
| Insurance contract or identification number | 469442 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 697953 |
| Policy instance | 1 |
| Insurance contract or identification number | 697953 | | Number of Individuals Covered | 3650 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,168,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | BM1658 |
| Policy instance | 4 |
| Insurance contract or identification number | BM1658 | | Number of Individuals Covered | 443 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,320,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 74686 |
| Policy instance | 2 |
| Insurance contract or identification number | 74686 | | Number of Individuals Covered | 8045 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $5,122 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 87240 |
| Policy instance | 3 |
| Insurance contract or identification number | 87240 | | Number of Individuals Covered | 4897 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $320,792 | | 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 | 29316-4/LIFE |
| Policy instance | 5 |
| Insurance contract or identification number | 29316-4/LIFE | | Number of Individuals Covered | 25201 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $135,188 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,703,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600690 |
| Policy instance | 6 |
| Insurance contract or identification number | 600690 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $193,980 | | 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 | 29316-4/EXRK |
| Policy instance | 7 |
| Insurance contract or identification number | 29316-4/EXRK | | Number of Individuals Covered | 4755 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $75,180 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,503,598 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B74689/H74686 |
| Policy instance | 9 |
| Insurance contract or identification number | B74689/H74686 | | Number of Individuals Covered | 4425 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $5,122 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,888,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 469442 |
| Policy instance | 10 |
| Insurance contract or identification number | 469442 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $108,208 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 697953 |
| Policy instance | 1 |
| Insurance contract or identification number | 697953 | | Number of Individuals Covered | 2348 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $822,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 469442-50/51 |
| Policy instance | 10 |
| Insurance contract or identification number | 469442-50/51 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | B74689/H74686 |
| Policy instance | 11 |
| Insurance contract or identification number | B74689/H74686 | | Number of Individuals Covered | 4501 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,745,346 | | 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 | 170198 |
| Policy instance | 8 |
| Insurance contract or identification number | 170198 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $605,473 | | 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 | 29316-4/EXRK |
| Policy instance | 7 |
| Insurance contract or identification number | 29316-4/EXRK | | Number of Individuals Covered | 4314 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $36,078 | | Total amount of fees paid to insurance company | USD $60,130 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,202,595 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 600690 |
| Policy instance | 6 |
| Insurance contract or identification number | 600690 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $157,277 | | 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 | 29316-4/LIFE |
| Policy instance | 5 |
| Insurance contract or identification number | 29316-4/LIFE | | Number of Individuals Covered | 5539 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $96,741 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,934,813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | BM1658 |
| Policy instance | 4 |
| Insurance contract or identification number | BM1658 | | Number of Individuals Covered | 399 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,016,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 87240 |
| Policy instance | 3 |
| Insurance contract or identification number | 87240 | | Number of Individuals Covered | 2632 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $221,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) |
| Policy contract number | 74686 |
| Policy instance | 2 |
| Insurance contract or identification number | 74686 | | Number of Individuals Covered | 7614 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $4,832 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 697953 |
| Policy instance | 1 |
| Insurance contract or identification number | 697953 | | Number of Individuals Covered | 2084 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $661,602 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
