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| Plan Name | MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | MOUNTAIN STATES HEALTH ALLIANCE |
| Employer identification number (EIN): | 620476282 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
Additional information about MOUNTAIN STATES HEALTH ALLIANCE
| Jurisdiction of Incorporation: | Virginia Secretary of State |
| Incorporation Date: | 2006-10-24 |
| Company Identification Number: | F168713 |
| Legal Registered Office Address: |
HANCOCK, DANIEL, JOHNSON & NAGLE, P.C. 4701 COX ROAD, SUITE 400 GLEN ALLEN United States of America (USA) 23060 |
More information about MOUNTAIN STATES HEALTH ALLIANCE
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-07-01 | CYNTHIA COX | 2019-04-12 | ||
| 501 | 2016-07-01 | BJ GALLATIN | BJ GALLATIN | 2018-01-18 | |
| 501 | 2015-07-01 | BJ GALLATIN | BJ GALLATIN | 2017-01-26 | |
| 501 | 2014-07-01 | BJ GALLATIN | BJ GALLATIN | 2016-01-29 | |
| 501 | 2013-07-01 | BJ GALLATIN | BJ GALLATIN | 2015-01-30 | |
| 501 | 2012-07-01 | BJ GALLATIN | BJ GALLATIN | 2014-01-30 | |
| 501 | 2011-07-01 | BJ GALLATIN | |||
| 501 | 2009-07-01 | BJ GALLATIN | |||
| 501 | 2008-07-01 | BJ GALLATIN | 2010-01-29 |
| Measure | Date | Value |
|---|---|---|
| 2017: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-07-01 | 6,978 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 7,209 |
| Number of retired or separated participants receiving benefits | 2017-07-01 | 153 |
| Total of all active and inactive participants | 2017-07-01 | 7,362 |
| 2016: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-07-01 | 7,665 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 6,476 |
| Number of retired or separated participants receiving benefits | 2016-07-01 | 150 |
| Total of all active and inactive participants | 2016-07-01 | 6,626 |
| Total participants | 2016-07-01 | 6,626 |
| 2015: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-07-01 | 7,927 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 7,576 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 89 |
| Total of all active and inactive participants | 2015-07-01 | 7,665 |
| Total participants | 2015-07-01 | 7,665 |
| 2014: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-07-01 | 7,705 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 7,839 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 88 |
| Total of all active and inactive participants | 2014-07-01 | 7,927 |
| Total participants | 2014-07-01 | 7,927 |
| 2013: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-07-01 | 7,730 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 7,626 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 79 |
| Total of all active and inactive participants | 2013-07-01 | 7,705 |
| Total participants | 2013-07-01 | 7,705 |
| 2012: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-07-01 | 7,206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 7,651 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 75 |
| Total of all active and inactive participants | 2012-07-01 | 7,726 |
| Total participants | 2012-07-01 | 7,726 |
| 2011: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-07-01 | 7,206 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 7,188 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 74 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
| Total of all active and inactive participants | 2011-07-01 | 7,262 |
| Total participants | 2011-07-01 | 7,262 |
| 2009: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-07-01 | 6,544 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 6,782 |
| Total of all active and inactive participants | 2009-07-01 | 6,782 |
| Total participants | 2009-07-01 | 6,782 |
| 2008: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2008 401k membership | ||
| Total participants, beginning-of-year | 2008-07-01 | 5,824 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-07-01 | 6,544 |
| Total of all active and inactive participants | 2008-07-01 | 6,544 |
| Total participants | 2008-07-01 | 6,544 |
| 2017: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | This submission is the final filing | Yes |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2016 form 5500 responses | ||
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2015 form 5500 responses | ||
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2014 form 5500 responses | ||
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2013 form 5500 responses | ||
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2012 form 5500 responses | ||
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2011 form 5500 responses | ||
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2009 form 5500 responses | ||
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | Yes |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: MOUNTAIN STATES HEALTH ALLIANCE BENEFITS PLAN 2008 form 5500 responses | ||
| 2008-07-01 | Type of plan entity | Single employer plan |
| 2008-07-01 | Submission has been amended | No |
| 2008-07-01 | This submission is the final filing | No |
| 2008-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-07-01 | Plan is a collectively bargained plan | No |
| 2008-07-01 | Plan funding arrangement – Insurance | Yes |
| 2008-07-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 ) | |
| Policy contract number | 6251 |
| Policy instance | 13 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 130422 |
| Policy instance | 14 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 130422 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR205846 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL151535 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD124305 |
| Policy instance | 5 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL151536 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR205847 |
| Policy instance | 6 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VPS326292 |
| Policy instance | 7 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 0000006754 |
| Policy instance | 8 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 0009094334 |
| Policy instance | 9 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 499567 |
| Policy instance | 10 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30013965 |
| Policy instance | 11 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3721388 |
| Policy instance | 12 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 0000006754 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 499567 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30013965 |
| Policy instance | 2 |
| DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 ) | |
| Policy contract number | 6251 |
| Policy instance | 1 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 0009094334 |
| Policy instance | 5 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3721388 |
| Policy instance | 6 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VPS326292 |
| Policy instance | 7 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL151536 |
| Policy instance | 12 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL151535 |
| Policy instance | 11 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD124305 |
| Policy instance | 10 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR205847 |
| Policy instance | 9 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR205846 |
| Policy instance | 8 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 0009094334 |
| Policy instance | 12 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 0000006754 |
| Policy instance | 11 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR205846 |
| Policy instance | 7 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3721388 |
| Policy instance | 10 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR205847 |
| Policy instance | 9 |
| DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 ) | |
| Policy contract number | 6251 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30013965 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 499567 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VPS326292 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL151535 |
| Policy instance | 6 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD124305 |
| Policy instance | 5 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL151536 |
| Policy instance | 8 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 6754 |
| Policy instance | 5 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3721388 |
| Policy instance | 4 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 9094334 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30013965 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 499567 |
| Policy instance | 2 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 7 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 8 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VPS 326292 |
| Policy instance | 13 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 124305 |
| Policy instance | 12 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR 205847 |
| Policy instance | 11 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 151536 |
| Policy instance | 10 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 151535 |
| Policy instance | 9 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 6 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) | |
| Policy contract number | 9094334 |
| Policy instance | 7 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 6754 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 499567 |
| Policy instance | 4 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 2 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3721388 |
| Policy instance | 8 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30013965 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 499567 |
| Policy instance | 4 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 217955 |
| Policy instance | 2 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 6754 |
| Policy instance | 7 |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) | |
| Policy contract number | 4154 |
| Policy instance | 6 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30013965 |
| Policy instance | 5 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | ADDS-05986 |
| Policy instance | 1 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | FLX961955 |
| Policy instance | 2 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | OK 963551 |
| Policy instance | 8 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | FLK960276 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 499567 |
| Policy instance | 5 |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) | |
| Policy contract number | 4154 |
| Policy instance | 6 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30013965 |
| Policy instance | 7 |
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) | |
| Policy contract number | 6754 |
| Policy instance | 9 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | VDT960185 |
| Policy instance | 3 |
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