401k Plan data: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN plan

UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 401k Plan overview

Plan Name	UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN
Plan identification number	535

UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

UNIVERSITY OF MINNESOTA PHYSICIANS has sponsored the creation of one or more 401k plans.

Company Name: UNIVERSITY OF MINNESOTA PHYSICIANS

Employer identification number (EIN): 411843943

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
535 2016-01-01 R NICKOLAS NYHUS R NICKOLAS NYHUS 2017-07-19
535 2015-01-01 TROY WILHELM
535 2014-01-01 TROY WILHELM
535 2013-01-01 TODD ELLINGSON TODD ELLINGSON 2014-07-22
535 2012-01-01 TODD ELLINGSON
535 2011-01-01 BRENT WILDE
535 2010-01-01 BRENT WILDE
535 2009-01-01 PATTI A. ARNOLD

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
535	2016-01-01	R NICKOLAS NYHUS	R NICKOLAS NYHUS	2017-07-19
535	2015-01-01	TROY WILHELM
535	2014-01-01	TROY WILHELM
535	2013-01-01	TODD ELLINGSON	TODD ELLINGSON	2014-07-22
535	2012-01-01	TODD ELLINGSON
535	2011-01-01	BRENT WILDE
535	2010-01-01	BRENT WILDE
535	2009-01-01	PATTI A. ARNOLD

Plan Statistics for UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

401k plan membership statisitcs for UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Measure Date Value
2016: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,699
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
2015: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,650
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,674
Number of retired or separated participants receiving benefits 2015-01-01 25
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1,699
2014: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,651
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,585
Number of retired or separated participants receiving benefits 2014-01-01 22
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 1,607
2013: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,349
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,441
Number of retired or separated participants receiving benefits 2013-01-01 14
Total of all active and inactive participants 2013-01-01 2,455
Total participants 2013-01-01 2,455
2012: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2,216
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2,314
Total of all active and inactive participants 2012-01-01 2,314
Total participants 2012-01-01 2,314
2011: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,083
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2,174
Number of retired or separated participants receiving benefits 2011-01-01 2
Total of all active and inactive participants 2011-01-01 2,176
Total participants 2011-01-01 2,176
2010: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 2,026
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 2,034
Number of retired or separated participants receiving benefits 2010-01-01 23
Total of all active and inactive participants 2010-01-01 2,057
Total participants 2010-01-01 2,057
2009: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2,010
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2,011
Number of retired or separated participants receiving benefits 2009-01-01 10
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 2,021

Measure	Date	Value
2016: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,699
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
2015: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,650
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,674
Number of retired or separated participants receiving benefits	2015-01-01	25
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1,699
2014: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,651
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,585
Number of retired or separated participants receiving benefits	2014-01-01	22
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	1,607
2013: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,349
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,441
Number of retired or separated participants receiving benefits	2013-01-01	14
Total of all active and inactive participants	2013-01-01	2,455
Total participants	2013-01-01	2,455
2012: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,216
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,314
Total of all active and inactive participants	2012-01-01	2,314
Total participants	2012-01-01	2,314
2011: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,083
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,174
Number of retired or separated participants receiving benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	2,176
Total participants	2011-01-01	2,176
2010: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	2,026
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2,034
Number of retired or separated participants receiving benefits	2010-01-01	23
Total of all active and inactive participants	2010-01-01	2,057
Total participants	2010-01-01	2,057
2009: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2,010
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2,011
Number of retired or separated participants receiving benefits	2009-01-01	10
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	2,021

Form 5500 Responses for UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

2016: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: UNIVERSITY OF MINNESOTA PHYSICIANS LIFE, VOLUNTARY LIFE & ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

FLX 965008

Policy instance

Insurance contract or identification number	FLX 965008
Number of Individuals Covered	1674
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $385,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 966612

Policy instance

Insurance contract or identification number	OK 966612
Number of Individuals Covered	1674
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $46,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX 965008

Policy instance

Insurance contract or identification number	FLX 965008
Number of Individuals Covered	1585
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
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $412,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 966612

Policy instance

Insurance contract or identification number	OK 966612
Number of Individuals Covered	1585
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
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $48,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

676358G

Policy instance

Insurance contract or identification number	676358G
Number of Individuals Covered	1995
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $974
Total amount of fees paid to insurance company	USD $1,628
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $25,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $974
Amount paid for insurance broker fees	1628
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

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

Policy contract number

OK966612

Policy instance

Insurance contract or identification number	OK966612
Number of Individuals Covered	1616
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
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $33,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX965008

Policy instance

Insurance contract or identification number	FLX965008
Number of Individuals Covered	1616
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
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $311,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

676358G

Policy instance

Insurance contract or identification number	676358G
Number of Individuals Covered	2230
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,928
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $341,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,928
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING

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

Policy contract number

ADDS06944

Policy instance

Insurance contract or identification number	ADDS06944
Number of Individuals Covered	2230
Insurance policy start date	2012-01-01
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $44,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

676358G

Policy instance

Insurance contract or identification number	676358G
Number of Individuals Covered	2119
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $13,178
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $283,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

ADDS06944

Policy instance

Insurance contract or identification number	ADDS06944
Number of Individuals Covered	2119
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,299
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $42,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

676358G

Policy instance

Insurance contract or identification number	676358G
Number of Individuals Covered	2057
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $13,541
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,541
Amount paid for insurance broker fees	7729
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	CBIZ BENEFITS & INSURANCE SERVICECS

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

Policy contract number

ADDS06944

Policy instance

Insurance contract or identification number	ADDS06944
Number of Individuals Covered	2057
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,396
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $27,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,396
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	CBIZ BENEFITS & INSURANCE SERVICES

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Company Name:	UNIVERSITY OF MINNESOTA PHYSICIANS
Employer identification number (EIN):	411843943
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)