RUTLAND REGIONAL MEDICAL CENTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE
401k plan membership statisitcs for RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE
| Measure | Date | Value |
|---|
| 2022: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,419 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,384 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 28 |
| 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 | 1,412 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,401 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,395 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 24 |
| 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 | 1,419 |
| 2020: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,441 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,392 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 9 |
| 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 | 1,401 |
| 2019: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,419 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,431 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 10 |
| 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 | 1,441 |
| 2018: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,423 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,408 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 11 |
| Total of all active and inactive participants | 2018-01-01 | 1,419 |
| Total participants | 2018-01-01 | 1,419 |
| 2017: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,066 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,400 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 23 |
| Total of all active and inactive participants | 2017-01-01 | 1,423 |
| Total participants | 2017-01-01 | 1,423 |
| 2016: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,065 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,041 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 25 |
| Total of all active and inactive participants | 2016-01-01 | 1,066 |
| Total participants | 2016-01-01 | 1,066 |
| 2015: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,018 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 47 |
| Total of all active and inactive participants | 2015-01-01 | 1,065 |
| Total participants | 2015-01-01 | 1,065 |
| 2014: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,076 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 56 |
| 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 | 1,132 |
| Total participants | 2014-01-01 | 1,132 |
| 2013: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 1,318 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,212 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 25 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 25 |
| Total of all active and inactive participants | 2013-01-01 | 1,262 |
| 2012: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 1,344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,268 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 25 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 25 |
| Total of all active and inactive participants | 2012-01-01 | 1,318 |
| 2011: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 958 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 1,278 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 31 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 35 |
| Total of all active and inactive participants | 2011-01-01 | 1,344 |
| 2009: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 906 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 892 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 32 |
| 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 | 924 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 924 |
| 2022: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 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: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | Yes |
| 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 funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: RUTLAND HOSPITAL, INC. EMPLOYEE HEALTH, DENTAL AND VISION INSURANCE 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 funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68980-7 |
| Policy instance | 3 |
| Insurance contract or identification number | 68980-7 | | Number of Individuals Covered | 2406 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $47,859 | | Total amount of fees paid to insurance company | USD $9,956 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $515,730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | G-71264-VT |
| Policy instance | 2 |
| Insurance contract or identification number | G-71264-VT | | Number of Individuals Covered | 1014 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $43,877 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $877,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| Insurance contract or identification number | 12320994 | | Number of Individuals Covered | 886 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $128,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68980-7 |
| Policy instance | 3 |
| Insurance contract or identification number | 68980-7 | | Number of Individuals Covered | 1384 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $46,117 | | Total amount of fees paid to insurance company | USD $9,304 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $497,782 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 901301 |
| Policy instance | 2 |
| Insurance contract or identification number | 901301 | | Number of Individuals Covered | 1416 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $45,837 | | Total amount of fees paid to insurance company | USD $16,101 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $773,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| Insurance contract or identification number | 12320994 | | Number of Individuals Covered | 893 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $135,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 901301 |
| Policy instance | 2 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70474-1 |
| Policy instance | 4 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68980-7 |
| Policy instance | 3 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68980-7 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 901301 |
| Policy instance | 2 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70474-1 |
| Policy instance | 4 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 901301 |
| Policy instance | 2 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68980-7 |
| Policy instance | 3 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70474-1 |
| Policy instance | 4 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 901301 |
| Policy instance | 2 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68980-7 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70474-1 |
| Policy instance | 4 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3810261147-01 |
| Policy instance | 2 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3810261147-01 |
| Policy instance | 3 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68980-7 |
| Policy instance | 4 |
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-2760 |
| Policy instance | 5 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-810-261147- |
| Policy instance | 5 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3-810-261147- |
| Policy instance | 4 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3-810-261147- |
| Policy instance | 3 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL10000103-151 |
| Policy instance | 2 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL10000103-141 |
| Policy instance | 2 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3-810-261147- |
| Policy instance | 3 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-810-261147- |
| Policy instance | 5 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3-810-261147- |
| Policy instance | 4 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | PD3-810-261147- |
| Policy instance | 6 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GD3-810-261147- |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL 10000103-131 |
| Policy instance | 2 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | SA3-810-261147- |
| Policy instance | 4 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) |
| Policy contract number | GF3-810-261147- |
| Policy instance | 5 |
| THE VERMONT HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95696 ) |
| Policy contract number | 22373 |
| Policy instance | 3 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 4 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 677993G |
| Policy instance | 5 |
| BLUE CROSS AND BLUE SHIELD OF VERMONT (National Association of Insurance Commissioners NAIC id number: 53295 ) |
| Policy contract number | 22373 |
| Policy instance | 2 |
| DELTA DENTAL PLAN OF VERMONT, INC. (National Association of Insurance Commissioners NAIC id number: 53279 ) |
| Policy contract number | 000007532 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 4 |
| BLUE CROSS AND BLUE SHIELD OF VERMONT (National Association of Insurance Commissioners NAIC id number: 53295 ) |
| Policy contract number | 22373 |
| Policy instance | 1 |
| DELTA DENTAL PLAN OF VERMONT, INC. (National Association of Insurance Commissioners NAIC id number: 53279 ) |
| Policy contract number | 00007532 |
| Policy instance | 2 |
| THE VERMONT HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95696 ) |
| Policy contract number | 22373 |
| Policy instance | 3 |
| BLUE CROSS AND BLUE SHIELD OF VERMONT (National Association of Insurance Commissioners NAIC id number: 53295 ) |
| Policy contract number | 22373 |
| Policy instance | 2 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12320994 |
| Policy instance | 3 |
| DELTA DENTAL PLAN OF VERMONT, INC. (National Association of Insurance Commissioners NAIC id number: 53279 ) |
| Policy contract number | 000007532 |
| Policy instance | 4 |
| THE VERMONT HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95696 ) |
| Policy contract number | 22373 |
| Policy instance | 1 |
