401k Plan data: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES plan

MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 401k Plan overview

Plan Name	MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES
Plan identification number	502

MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Other welfare benefit cover

401k Sponsoring company profile

ALTRIA CLIENT SERVICES LLC has sponsored the creation of one or more 401k plans.

Company Name: ALTRIA CLIENT SERVICES LLC

Employer identification number (EIN): 472929146

NAIC Classification: 312200
NAIC Description: Tobacco Manufacturing

Additional information about ALTRIA CLIENT SERVICES LLC

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 2013-02-27

Company Identification Number: S443360

Legal Registered Office Address: 6601 West Broad Street

Richmond
United States of America (USA)
23230

More information about ALTRIA CLIENT SERVICES LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2021-01-01
502 2020-01-01
502 2019-01-01
502 2018-01-01
502 2017-01-01 THOMAS HOUGHTALING
502 2016-01-01 SCOTT SCOFIELD
502 2015-01-01 SCOTT SCOFIELD

Plan Statistics for MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES

401k plan membership statisitcs for MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES

Measure Date Value
2022: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2022 401k membership
Total participants, beginning-of-year 2022-01-01 10,365
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 4,173
Number of retired or separated participants receiving benefits 2022-01-01 6,188
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 10,361
2021: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2021 401k membership
Total participants, beginning-of-year 2021-01-01 10,956
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 4,013
Number of retired or separated participants receiving benefits 2021-01-01 6,352
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 10,365
2020: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2020 401k membership
Total participants, beginning-of-year 2020-01-01 11,148
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 4,471
Number of retired or separated participants receiving benefits 2020-01-01 6,485
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 10,956
2019: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2019 401k membership
Total participants, beginning-of-year 2019-01-01 11,361
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 4,828
Number of retired or separated participants receiving benefits 2019-01-01 6,320
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 11,148
2018: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2018 401k membership
Total participants, beginning-of-year 2018-01-01 10,687
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 5,096
Number of retired or separated participants receiving benefits 2018-01-01 6,265
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 11,361
2017: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2017 401k membership
Total participants, beginning-of-year 2017-01-01 10,881
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 4,986
Number of retired or separated participants receiving benefits 2017-01-01 5,701
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 10,687
2016: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2016 401k membership
Total participants, beginning-of-year 2016-01-01 11,210
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 5,127
Number of retired or separated participants receiving benefits 2016-01-01 5,754
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 10,881
2015: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2015 401k membership
Total participants, beginning-of-year 2015-01-01 11,446
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 5,320
Number of retired or separated participants receiving benefits 2015-01-01 5,890
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 11,210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 11,210

Measure	Date	Value
2022: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2022 401k membership
Total participants, beginning-of-year	2022-01-01	10,365
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	4,173
Number of retired or separated participants receiving benefits	2022-01-01	6,188
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	10,361
2021: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2021 401k membership
Total participants, beginning-of-year	2021-01-01	10,956
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	4,013
Number of retired or separated participants receiving benefits	2021-01-01	6,352
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	10,365
2020: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2020 401k membership
Total participants, beginning-of-year	2020-01-01	11,148
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	4,471
Number of retired or separated participants receiving benefits	2020-01-01	6,485
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	10,956
2019: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2019 401k membership
Total participants, beginning-of-year	2019-01-01	11,361
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	4,828
Number of retired or separated participants receiving benefits	2019-01-01	6,320
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	11,148
2018: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2018 401k membership
Total participants, beginning-of-year	2018-01-01	10,687
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	5,096
Number of retired or separated participants receiving benefits	2018-01-01	6,265
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	11,361
2017: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2017 401k membership
Total participants, beginning-of-year	2017-01-01	10,881
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	4,986
Number of retired or separated participants receiving benefits	2017-01-01	5,701
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	10,687
2016: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2016 401k membership
Total participants, beginning-of-year	2016-01-01	11,210
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	5,127
Number of retired or separated participants receiving benefits	2016-01-01	5,754
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	10,881
2015: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2015 401k membership
Total participants, beginning-of-year	2015-01-01	11,446
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	5,320
Number of retired or separated participants receiving benefits	2015-01-01	5,890
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	11,210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	11,210

Financial Data on MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES

Measure	Date	Value
2019 : MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$12,168,460
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$12,168,460
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$14,448,461
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$14,448,461
Total income from all sources (including contributions)	2019-12-31	$66,440,196
Total income from all sources (including contributions)	2019-12-31	$66,440,196
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$140,075,818
Total of all expenses incurred	2019-12-31	$140,075,818
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$134,264,790
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$134,264,790
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$66,022,015
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$66,022,015
Value of total assets at end of year	2019-12-31	$1,772,839
Value of total assets at end of year	2019-12-31	$1,772,839
Value of total assets at beginning of year	2019-12-31	$77,688,462
Value of total assets at beginning of year	2019-12-31	$77,688,462
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$5,811,028
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$5,811,028
Total interest from all sources	2019-12-31	$418,181
Total interest from all sources	2019-12-31	$418,181
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$180,388
Administrative expenses professional fees incurred	2019-12-31	$180,388
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$10,000,000
Value of fidelity bond cover	2019-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$28,047,405
Contributions received from participants	2019-12-31	$28,047,405
Participant contributions at end of year	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$2,484,163
Participant contributions at beginning of year	2019-12-31	$2,484,163
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$1,772,839
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$1,772,839
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$3,963,006
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$3,963,006
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$619,475
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$2,967,925
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$2,967,925
Liabilities. Value of operating payables at end of year	2019-12-31	$377
Liabilities. Value of operating payables at end of year	2019-12-31	$377
Liabilities. Value of operating payables at beginning of year	2019-12-31	$2,219
Liabilities. Value of operating payables at beginning of year	2019-12-31	$2,219
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$-73,635,622
Value of net income/loss	2019-12-31	$-73,635,622
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$-10,395,621
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$-10,395,621
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$63,240,001
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$63,240,001
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$1,241,293
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$1,241,293
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$1,241,293
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$1,241,293
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$418,181
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$418,181
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$9,523,712
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$9,523,712
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$37,974,610
Contributions received in cash from employer	2019-12-31	$37,974,610
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$70,000,000
Employer contributions (assets) at beginning of year	2019-12-31	$70,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$124,741,078
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$124,741,078
Contract administrator fees	2019-12-31	$5,630,640
Contract administrator fees	2019-12-31	$5,630,640
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$11,548,608
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$11,548,608
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$11,478,317
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$11,478,317
Did the plan have assets held for investment	2019-12-31	No
Did the plan have assets held for investment	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	PRICEWATERHOUSECOOPERS LLP
Accountancy firm name	2019-12-31	PRICEWATERHOUSECOOPERS LLP
Accountancy firm EIN	2019-12-31	134008324
Accountancy firm EIN	2019-12-31	134008324
2018 : MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$14,448,461
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$12,266,675
Total income from all sources (including contributions)	2018-12-31	$135,513,359
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$140,423,201
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$134,081,664
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$135,275,369
Value of total assets at end of year	2018-12-31	$77,688,462
Value of total assets at beginning of year	2018-12-31	$80,416,518
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$6,341,537
Total interest from all sources	2018-12-31	$237,990
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$214,604
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$75,000,000
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$30,406,103
Participant contributions at end of year	2018-12-31	$2,484,163
Participant contributions at beginning of year	2018-12-31	$2,279,466
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$3,963,006
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$5,640,721
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$2,967,925
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Liabilities. Value of operating payables at end of year	2018-12-31	$2,219
Liabilities. Value of operating payables at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-4,909,842
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$63,240,001
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$68,149,843
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$1,241,293
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$2,496,331
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$2,496,331
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$237,990
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$12,456,152
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$104,869,266
Employer contributions (assets) at end of year	2018-12-31	$70,000,000
Employer contributions (assets) at beginning of year	2018-12-31	$70,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$121,625,512
Contract administrator fees	2018-12-31	$6,126,933
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$11,478,317
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$12,266,675
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	PRICEWATERHOUSECOOPERS LLP
Accountancy firm EIN	2018-12-31	134008324
2017 : MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$12,266,675
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$11,073,424
Total income from all sources (including contributions)	2017-12-31	$133,664,417
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$131,290,428
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$124,956,756
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$133,562,489
Value of total assets at end of year	2017-12-31	$80,416,518
Value of total assets at beginning of year	2017-12-31	$76,849,278
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$6,333,672
Total interest from all sources	2017-12-31	$101,928
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$197,000
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$75,000,000
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$28,447,346
Participant contributions at end of year	2017-12-31	$2,279,466
Participant contributions at beginning of year	2017-12-31	$2,372,635
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$5,640,721
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$4,476,643
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$0
Liabilities. Value of operating payables at end of year	2017-12-31	$0
Liabilities. Value of operating payables at beginning of year	2017-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$2,373,989
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$68,149,843
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$65,775,854
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$2,496,331
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$101,928
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$5,674,918
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$105,115,143
Employer contributions (assets) at end of year	2017-12-31	$70,000,000
Employer contributions (assets) at beginning of year	2017-12-31	$70,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$119,281,838
Contract administrator fees	2017-12-31	$6,136,672
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$12,266,675
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$11,073,424
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	PRICEWATERHOUSECOOPERS LLP
Accountancy firm EIN	2017-12-31	134008324
2016 : MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$11,073,424
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$12,218,589
Total income from all sources (including contributions)	2016-12-31	$151,678,194
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$149,067,854
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$142,961,610
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$151,678,194
Value of total assets at end of year	2016-12-31	$76,849,278
Value of total assets at beginning of year	2016-12-31	$75,384,103
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$6,106,244
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$197,662
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$75,000,000
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$30,006,079
Participant contributions at end of year	2016-12-31	$2,372,635
Participant contributions at beginning of year	2016-12-31	$2,018,394
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$4,476,643
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$3,365,709
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$4,998
Liabilities. Value of operating payables at end of year	2016-12-31	$0
Liabilities. Value of operating payables at beginning of year	2016-12-31	$1,074,856
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	$2,610,340
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$65,775,854
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$63,165,514
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
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$5,673,697
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
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	$121,672,115
Employer contributions (assets) at end of year	2016-12-31	$70,000,000
Employer contributions (assets) at beginning of year	2016-12-31	$70,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$137,287,913
Contract administrator fees	2016-12-31	$5,908,582
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$11,073,424
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$11,138,735
Did the plan have assets held for investment	2016-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	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	PRICEWATERHOUSECOOPERS LLP
Accountancy firm EIN	2016-12-31	134008324
2015 : MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$12,218,589
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$13,448,168
Total income from all sources (including contributions)	2015-12-31	$156,545,579
Total of all expenses incurred	2015-12-31	$151,894,218
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$145,984,402
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$156,545,579
Value of total assets at end of year	2015-12-31	$75,384,103
Value of total assets at beginning of year	2015-12-31	$71,962,321
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$5,909,816
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$177,498
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$75,000,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$24,221,596
Participant contributions at end of year	2015-12-31	$2,018,394
Participant contributions at beginning of year	2015-12-31	$1,962,321
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$3,365,709
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$4,998
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$31,212
Liabilities. Value of operating payables at end of year	2015-12-31	$1,074,856
Liabilities. Value of operating payables at beginning of year	2015-12-31	$2,621,059
Total non interest bearing cash at beginning of year	2015-12-31	$0
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	$4,651,361
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$63,165,514
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$58,514,153
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
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$9,700,693
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
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	$132,323,983
Employer contributions (assets) at end of year	2015-12-31	$70,000,000
Employer contributions (assets) at beginning of year	2015-12-31	$70,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$136,283,709
Contract administrator fees	2015-12-31	$5,732,318
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$11,138,735
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$10,795,897
Did the plan have assets held for investment	2015-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	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	PRICEWATERHOUSECOOPERS LLP
Accountancy firm EIN	2015-12-31	134008324

Form 5500 Responses for MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES

2022: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 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	No
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 funding arrangement – Trust	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MEDICAL, DENTAL AND RETIREE LIFE BENEFITS PLAN FOR SALARIED EMPLOYEES 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 funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

807900G

Policy instance

Insurance contract or identification number	807900G
Number of Individuals Covered	4876
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
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

807900G

Policy instance

Insurance contract or identification number	807900G
Number of Individuals Covered	5081
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
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

807900G

Policy instance

Insurance contract or identification number	807900G
Number of Individuals Covered	5223
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Were dividends or retroactive rate refunds paid as a credit?	No
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

807900G

Policy instance

Insurance contract or identification number	807900G
Number of Individuals Covered	5381
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05753A

Policy instance

Insurance contract or identification number	05753A
Number of Individuals Covered	1
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
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	Yes
Dental Insurance Welfare Benefit	Yes
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	EVACUATION COVERAGE
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 $16,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05753A

Policy instance

Insurance contract or identification number	05753A
Number of Individuals Covered	8
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
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	Yes
Dental Insurance Welfare Benefit	Yes
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	EVACUATION COVERAGE
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 $33,926
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

0016723

Policy instance

Insurance contract or identification number	0016723
Number of Individuals Covered	5546
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004950

Policy instance

Insurance contract or identification number	SP0004950
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $355
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
Dental Insurance Welfare Benefit	Yes
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
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 $7,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $355
Insurance broker organization code?	3
Insurance broker name	IKON SOLUTIONS INC.

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0016723

Policy instance

Insurance contract or identification number	0016723
Number of Individuals Covered	5696
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05753A

Policy instance

Insurance contract or identification number	05753A
Number of Individuals Covered	9
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
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	Yes
Dental Insurance Welfare Benefit	Yes
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	EVACUATION COVERAGE
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 $47,429
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

0016723

Policy instance

Insurance contract or identification number	0016723
Number of Individuals Covered	5884
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
Life Insurance Welfare Benefit	Yes
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )

Policy contract number

SP0004950

Policy instance

Insurance contract or identification number	SP0004950
Number of Individuals Covered	10
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,613
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,613
Insurance broker organization code?	3
Insurance broker name	IKON BENEFITS GROUP, INC.

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05753A

Policy instance

Insurance contract or identification number	05753A
Number of Individuals Covered	6
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
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EVACUATION COVERAGE
Welfare Benefit Premiums Paid to Carrier	USD $158,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ALTRIA CLIENT SERVICES LLC
Employer identification number (EIN):	472929146
NAIC Classification:	312200
NAIC Description:	Tobacco Manufacturing

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	2013-02-27
Company Identification Number:	S443360
Legal Registered Office Address:	6601 West Broad Street Richmond United States of America (USA) 23230