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| Plan Name | RAINBOW USA, INC. MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | AIJJ ENTERPRISES, INC |
| Employer identification number (EIN): | 133070879 |
| NAIC Classification: | 448120 |
| NAIC Description: | Women's Clothing Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2016-01-01 | ADIN C. GOLDBERG | |||
| 501 | 2015-01-01 | ADIN C GOLDBERG | |||
| 501 | 2014-01-01 | ADIN GOLDBERG | |||
| 501 | 2013-01-01 | ADIN GOLDBERG | |||
| 501 | 2012-01-01 | ADIN GOLDBERG | |||
| 501 | 2011-01-01 | ADIN GOLDBERG | |||
| 501 | 2010-01-01 | ADIN GOLDBERG | |||
| 501 | 2009-01-01 | ADIN GOLDBERG | |||
| 501 | 2009-01-01 | CARL BIANCHI | |||
| 501 | 2009-01-01 | CARL BIANCHI | |||
| 501 | 2009-01-01 | CARL BIANCHI |
| Measure | Date | Value |
|---|---|---|
| 2010 : RAINBOW USA, INC. MEDICAL PLAN 2010 401k financial data | ||
| Unrealized appreciation/depreciation of real estate assets | 2010-12-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2010-12-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $0 |
| Total transfer of assets to this plan | 2010-12-31 | $0 |
| Total transfer of assets from this plan | 2010-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $0 |
| Expenses. Interest paid | 2010-12-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2010-12-31 | $0 |
| Total income from all sources (including contributions) | 2010-12-31 | $0 |
| Total loss/gain on sale of assets | 2010-12-31 | $0 |
| Total of all expenses incurred | 2010-12-31 | $0 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $0 |
| Expenses. Certain deemed distributions of participant loans | 2010-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $0 |
| Value of total assets at end of year | 2010-12-31 | $0 |
| Value of total assets at beginning of year | 2010-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $0 |
| Total income from rents | 2010-12-31 | $0 |
| Total interest from all sources | 2010-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2010-12-31 | $0 |
| Assets. Real estate other than employer real property at end of year | 2010-12-31 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2010-12-31 | $0 |
| Administrative expenses professional fees incurred | 2010-12-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2010-12-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2010-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $0 |
| Participant contributions at end of year | 2010-12-31 | $0 |
| Participant contributions at beginning of year | 2010-12-31 | $0 |
| Assets. Other investments not covered elsewhere at end of year | 2010-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2010-12-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2010-12-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2010-12-31 | $0 |
| Assets. Loans (other than to participants) at end of year | 2010-12-31 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2010-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $0 |
| Other income not declared elsewhere | 2010-12-31 | $0 |
| Administrative expenses (other) incurred | 2010-12-31 | $0 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $0 |
| Total non interest bearing cash at end of year | 2010-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $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 | 2010-12-31 | No |
| Income. Non cash contributions | 2010-12-31 | $0 |
| Value of net income/loss | 2010-12-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Assets. partnership/joint venture interests at end of year | 2010-12-31 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2010-12-31 | $0 |
| Investment advisory and management fees | 2010-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2010-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2010-12-31 | $0 |
| Value of interest in pooled separate accounts at end of year | 2010-12-31 | $0 |
| Value of interest in pooled separate accounts at beginning of year | 2010-12-31 | $0 |
| Interest on participant loans | 2010-12-31 | $0 |
| Income. Interest from loans (other than to participants) | 2010-12-31 | $0 |
| Interest earned on other investments | 2010-12-31 | $0 |
| Income. Interest from US Government securities | 2010-12-31 | $0 |
| Income. Interest from corporate debt instruments | 2010-12-31 | $0 |
| Value of interest in master investment trust accounts at end of year | 2010-12-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2010-12-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2010-12-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2010-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2010-12-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2010-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2010-12-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2010-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $0 |
| Asset value of US Government securities at end of year | 2010-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2010-12-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2010-12-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2010-12-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2010-12-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2010-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Assets. Invements in employer securities at end of year | 2010-12-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2010-12-31 | $0 |
| Contributions received in cash from employer | 2010-12-31 | $0 |
| Employer contributions (assets) at end of year | 2010-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $0 |
| Income. Dividends from preferred stock | 2010-12-31 | $0 |
| Income. Dividends from common stock | 2010-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $0 |
| Asset. Corporate debt instrument preferred debt at end of year | 2010-12-31 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2010-12-31 | $0 |
| Contract administrator fees | 2010-12-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $0 |
| Did the plan have assets held for investment | 2010-12-31 | 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 | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Aggregate proceeds on sale of assets | 2010-12-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2010-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2010-12-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2010-12-31 | $0 |
| 2016: RAINBOW USA, INC. MEDICAL PLAN 2016 form 5500 responses | ||
|---|---|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | 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 benefit arrangement – Insurance | Yes |
| 2015: RAINBOW USA, INC. MEDICAL PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: RAINBOW USA, INC. MEDICAL PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan 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: RAINBOW USA, INC. MEDICAL PLAN 2013 form 5500 responses | ||
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | Yes |
| 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: RAINBOW USA, INC. MEDICAL PLAN 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | Yes |
| 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: RAINBOW USA, INC. MEDICAL PLAN 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 |
| 2010: RAINBOW USA, INC. MEDICAL PLAN 2010 form 5500 responses | ||
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | Yes |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: RAINBOW USA, INC. MEDICAL PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | First time form 5500 has been submitted | Yes |
| 2009-01-01 | Submission has been amended | Yes |
| 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 |
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) | |
| Policy contract number | V255890 |
| Policy instance | 1 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0730543 |
| Policy instance | 6 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0730543 |
| Policy instance | 5 |
| HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 6090865 |
| Policy instance | 4 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 3 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 3215832 |
| Policy instance | 2 |
| SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 72664 ) | |
| Policy contract number | 811402 |
| Policy instance | 6 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000404002620 |
| Policy instance | 2 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 3215832 |
| Policy instance | 1 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | EG277 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000405003517 |
| Policy instance | 4 |
| SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 72664 ) | |
| Policy contract number | 818024 |
| Policy instance | 7 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 818024 |
| Policy instance | 8 |
| MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 ) | |
| Policy contract number | 79-790821 |
| Policy instance | 9 |
| ALLSTATE LIFE INSURANCE CO. OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70874 ) | |
| Policy contract number | NG590 |
| Policy instance | 3 |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) | |
| Policy contract number | XN7-ALL |
| Policy instance | 10 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 11 |
| ALLSTATE LIFE INSURANCE CO. OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70874 ) | |
| Policy contract number | NG590 |
| Policy instance | 9 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | EG277 |
| Policy instance | 8 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000404002620 |
| Policy instance | 7 |
| SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 72664 ) | |
| Policy contract number | 811402 |
| Policy instance | 6 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 3215832 |
| Policy instance | 5 |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) | |
| Policy contract number | XN7-ALL |
| Policy instance | 4 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 3 |
| MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 ) | |
| Policy contract number | 79-790821 |
| Policy instance | 2 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000405003517 |
| Policy instance | 1 |
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60093 ) | |
| Policy contract number | 235852 |
| Policy instance | 2 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 1 |
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60093 ) | |
| Policy contract number | 235852 |
| Policy instance | 3 |
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60093 ) | |
| Policy contract number | 235852 |
| Policy instance | 4 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 1 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | VIP 530887 |
| Policy instance | 3 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | LTD 118618 |
| Policy instance | 4 |
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) | |
| Policy contract number | 3215832 |
| Policy instance | 5 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | VIP 530887 |
| Policy instance | 1 |
| MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 ) | |
| Policy contract number | 79-790821 |
| Policy instance | 2 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 3 |
| ALLSTATE LIFE INSURANCE CO. OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70874 ) | |
| Policy contract number | NG590 |
| Policy instance | 7 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | LTD 118618 |
| Policy instance | 6 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | EG277 |
| Policy instance | 8 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 3215832 |
| Policy instance | 9 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | GL 144815 |
| Policy instance | 10 |
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60093 ) | |
| Policy contract number | 235852 |
| Policy instance | 2 |
| ALLSTATE LIFE INSURANCE CO. OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70874 ) | |
| Policy contract number | NG590 |
| Policy instance | 1 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | EG277 |
| Policy instance | 2 |
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) | |
| Policy contract number | 3215832 |
| Policy instance | 3 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | GL 144815 |
| Policy instance | 5 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | LTD 118618 |
| Policy instance | 6 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | VIP530887 |
| Policy instance | 7 |
| MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 ) | |
| Policy contract number | 79-790821 |
| Policy instance | 8 |
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60093 ) | |
| Policy contract number | 235852 |
| Policy instance | 9 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 4 |
| UNITEDHEALTHCARE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60093 ) | |
| Policy contract number | 235852 |
| Policy instance | 5 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | LTD 118618 |
| Policy instance | 4 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | GL 144815 |
| Policy instance | 8 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | EG277 |
| Policy instance | 9 |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) | |
| Policy contract number | 000064085406 |
| Policy instance | 1 |
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) | |
| Policy contract number | 3215832 |
| Policy instance | 2 |
| MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 ) | |
| Policy contract number | 79-790821 |
| Policy instance | 3 |
| ALLSTATE LIFE INSURANCE CO. OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70874 ) | |
| Policy contract number | NG590 |
| Policy instance | 7 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | VIP 530887 |
| Policy instance | 6 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 469810 |
| Policy instance | 1 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | VIP 530887 |
| Policy instance | 2 |
| CIGNA DENTAL HEALTH OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95037 ) | |
| Policy contract number | 3215832 |
| Policy instance | 3 |
| MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 ) | |
| Policy contract number | 79-790821 |
| Policy instance | 4 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | LTD 118618 |
| Policy instance | 5 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | GL 144815 |
| Policy instance | 6 |
| ALLSTATE LIFE INSURANCE CO. OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70874 ) | |
| Policy contract number | NG590 |
| Policy instance | 7 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | GL 144815 |
| Policy instance | 9 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | EG277 |
| Policy instance | 10 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) | |
| Policy contract number | LTD 118618 |
| Policy instance | 8 |
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