401k Plan data: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA plan

COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 401k Plan overview

Plan Name	COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA
Plan identification number	501

COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

COMMUNICATIONS TEST DESIGN, INC. has sponsored the creation of one or more 401k plans.

Company Name: COMMUNICATIONS TEST DESIGN, INC.

Employer identification number (EIN): 232015935

NAIC Classification: 334200

Additional information about COMMUNICATIONS TEST DESIGN, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1982-10-12

Company Identification Number: 0005625606

Legal Registered Office Address: 1373 ENTERPRISE DR

WEST CHESTER
United States of America (USA)
19380

More information about COMMUNICATIONS TEST DESIGN, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 ROBERT FEENAN 2024-01-29 ROBERT FEENAN 2024-01-29
501 2021-07-01 ROBERT FEENAN 2023-01-31 ROBERT FEENAN 2023-01-31
501 2020-07-01
501 2019-07-01
501 2018-07-01
501 2017-07-01 KEITH MONTONE
501 2016-07-01 KEITH MONTONE
501 2015-07-01 KEITH MONTONE
501 2014-07-01 KEITH MONTONE
501 2013-07-01 CONRAD OLIE
501 2012-07-01 CONRAD OLIE
501 2011-07-01 CONRAD OLIE
501 2010-07-01 CONRAD OLIE
501 2009-07-01 CONRAD OLIE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-07-01	ROBERT FEENAN	2024-01-29	ROBERT FEENAN	2024-01-29
501	2021-07-01	ROBERT FEENAN	2023-01-31	ROBERT FEENAN	2023-01-31
501	2020-07-01
501	2019-07-01
501	2018-07-01
501	2017-07-01	KEITH MONTONE
501	2016-07-01	KEITH MONTONE
501	2015-07-01	KEITH MONTONE
501	2014-07-01	KEITH MONTONE
501	2013-07-01	CONRAD OLIE
501	2012-07-01	CONRAD OLIE
501	2011-07-01	CONRAD OLIE
501	2010-07-01	CONRAD OLIE
501	2009-07-01	CONRAD OLIE

Plan Statistics for COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA

401k plan membership statisitcs for COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA

Measure Date Value
2022: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2022 401k membership
Total participants, beginning-of-year 2022-07-01 9,184
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 8,588
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 8,588
2021: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2021 401k membership
Total participants, beginning-of-year 2021-07-01 9,532
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 9,184
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 9,184
2020: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2020 401k membership
Total participants, beginning-of-year 2020-07-01 6,808
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 9,532
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 9,532
2019: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2019 401k membership
Total participants, beginning-of-year 2019-07-01 5,990
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 6,808
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 6,808
2018: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2018 401k membership
Total participants, beginning-of-year 2018-07-01 4,453
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 5,990
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 5,990
2017: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2017 401k membership
Total participants, beginning-of-year 2017-07-01 3,460
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 4,453
Total of all active and inactive participants 2017-07-01 4,453
2016: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2016 401k membership
Total participants, beginning-of-year 2016-07-01 2,741
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 3,460
Total of all active and inactive participants 2016-07-01 3,460
2015: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2015 401k membership
Total participants, beginning-of-year 2015-07-01 2,244
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 2,741
Total of all active and inactive participants 2015-07-01 2,741
2014: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2014 401k membership
Total participants, beginning-of-year 2014-07-01 2,020
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 2,244
Total of all active and inactive participants 2014-07-01 2,244
2013: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2013 401k membership
Total participants, beginning-of-year 2013-07-01 2,199
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 2,020
Total of all active and inactive participants 2013-07-01 2,020
2012: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2012 401k membership
Total participants, beginning-of-year 2012-07-01 2,074
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 2,199
Total of all active and inactive participants 2012-07-01 2,199
2011: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2011 401k membership
Total participants, beginning-of-year 2011-07-01 2,088
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 2,074
Total of all active and inactive participants 2011-07-01 2,074
2010: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2010 401k membership
Total participants, beginning-of-year 2010-07-01 2,044
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 2,088
Total of all active and inactive participants 2010-07-01 2,088
2009: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2009 401k membership
Total participants, beginning-of-year 2009-07-01 2,095
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 2,044
Total of all active and inactive participants 2009-07-01 2,044

Measure	Date	Value
2022: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2022 401k membership
Total participants, beginning-of-year	2022-07-01	9,184
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	8,588
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	8,588
2021: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2021 401k membership
Total participants, beginning-of-year	2021-07-01	9,532
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	9,184
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	9,184
2020: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2020 401k membership
Total participants, beginning-of-year	2020-07-01	6,808
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	9,532
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	9,532
2019: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2019 401k membership
Total participants, beginning-of-year	2019-07-01	5,990
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	6,808
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	6,808
2018: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2018 401k membership
Total participants, beginning-of-year	2018-07-01	4,453
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	5,990
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	5,990
2017: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2017 401k membership
Total participants, beginning-of-year	2017-07-01	3,460
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	4,453
Total of all active and inactive participants	2017-07-01	4,453
2016: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2016 401k membership
Total participants, beginning-of-year	2016-07-01	2,741
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	3,460
Total of all active and inactive participants	2016-07-01	3,460
2015: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2015 401k membership
Total participants, beginning-of-year	2015-07-01	2,244
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	2,741
Total of all active and inactive participants	2015-07-01	2,741
2014: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2014 401k membership
Total participants, beginning-of-year	2014-07-01	2,020
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	2,244
Total of all active and inactive participants	2014-07-01	2,244
2013: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2013 401k membership
Total participants, beginning-of-year	2013-07-01	2,199
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	2,020
Total of all active and inactive participants	2013-07-01	2,020
2012: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2012 401k membership
Total participants, beginning-of-year	2012-07-01	2,074
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	2,199
Total of all active and inactive participants	2012-07-01	2,199
2011: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2011 401k membership
Total participants, beginning-of-year	2011-07-01	2,088
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	2,074
Total of all active and inactive participants	2011-07-01	2,074
2010: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2010 401k membership
Total participants, beginning-of-year	2010-07-01	2,044
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	2,088
Total of all active and inactive participants	2010-07-01	2,088
2009: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2009 401k membership
Total participants, beginning-of-year	2009-07-01	2,095
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	2,044
Total of all active and inactive participants	2009-07-01	2,044

Form 5500 Responses for COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA

2022: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	Yes
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: COMMUNICATIONS TEST DESIGN,INC.WELFARE BENEFIT PLA 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	This submission is the final filing	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	7811
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	8709
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $5
Total amount of fees paid to insurance company	USD $3,949
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $169,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3588
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $5

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

4055340010SSLS

Policy instance

Insurance contract or identification number	4055340010SSLS
Number of Individuals Covered	4818
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $184,592
Welfare Benefit Premiums Paid to Carrier	USD $1,845,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $184,592
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	8709
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

ADDS09117

Policy instance

Insurance contract or identification number	ADDS09117
Number of Individuals Covered	8006
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of fees paid to insurance company	USD $1,319
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1319
Insurance broker organization code?	3

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	4818
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	858
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $28,922
Total amount of fees paid to insurance company	USD $5,164
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $169,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,922
Insurance broker organization code?	3
Amount paid for insurance broker fees	5164
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	929
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $50,194
Total amount of fees paid to insurance company	USD $6,962
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $258,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,194
Insurance broker organization code?	3
Amount paid for insurance broker fees	6962
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AETNA GLOBAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

029944001100224

Policy instance

Insurance contract or identification number	029944001100224
Number of Individuals Covered	64
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Other welfare benefits provided	AGB WORLDTRAVELER
Welfare Benefit Premiums Paid to Carrier	USD $1,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	8006
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Other welfare benefits provided	LIFE-BTRM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	738
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Other welfare benefits provided	LIFE-SDEP
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	1317
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Other welfare benefits provided	LIFE-VOL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 )

Policy contract number

A-0896

Policy instance

Insurance contract or identification number	A-0896
Number of Individuals Covered	8709
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $80,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80,187

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	1179
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Other welfare benefits provided	LTD-ABIL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	5077
Insurance policy start date	2021-04-01
Insurance policy end date	2023-03-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	9255
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	9255
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	9255
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

4055340010SSLS

Policy instance

Insurance contract or identification number	4055340010SSLS
Number of Individuals Covered	5077
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $135,050
Welfare Benefit Premiums Paid to Carrier	USD $1,350,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $135,050
Insurance broker organization code?	3

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	9255
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $20
Total amount of fees paid to insurance company	USD $8,618
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $195,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7544
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $20

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	881
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $23,389
Total amount of fees paid to insurance company	USD $6,462
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $184,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,389
Insurance broker organization code?	3
Amount paid for insurance broker fees	6462
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	1114
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Other welfare benefits provided	LTD-ABIL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

AETNA GLOBAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

029944001100224

Policy instance

Insurance contract or identification number	029944001100224
Number of Individuals Covered	64
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	AGB WORLDTRAVELER
Welfare Benefit Premiums Paid to Carrier	USD $3,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	8183
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Other welfare benefits provided	LIFE-BTRM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	764
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Other welfare benefits provided	LIFE-SDEP
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	1274
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Other welfare benefits provided	LIFE-VOL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 )

Policy contract number

A-0896

Policy instance

Insurance contract or identification number	A-0896
Number of Individuals Covered	9255
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $82,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,437

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	922
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $48,494
Total amount of fees paid to insurance company	USD $9,257
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $270,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,494
Insurance broker organization code?	3
Amount paid for insurance broker fees	9257
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	9255
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	9255
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	9255
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

4055340010SSLS

Policy instance

Insurance contract or identification number	4055340010SSLS
Number of Individuals Covered	5077
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $91,925
Welfare Benefit Premiums Paid to Carrier	USD $919,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $91,925
Insurance broker organization code?	3

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	9255
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $-3
Total amount of fees paid to insurance company	USD $818
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $173,207
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
Amount paid for insurance broker fees	818
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	874
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $40,287
Total amount of fees paid to insurance company	USD $3,003
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $210,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,287
Insurance broker organization code?	3
Amount paid for insurance broker fees	3003
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	911
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $60,012
Total amount of fees paid to insurance company	USD $3,878
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $293,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,012
Insurance broker organization code?	3
Amount paid for insurance broker fees	3878
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AETNA GLOBAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

029944001100099

Policy instance

Insurance contract or identification number	029944001100099
Number of Individuals Covered	64
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	AGB WORLDTRAVELER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	5077
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,504
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

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	1078
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Other welfare benefits provided	LTD-ABIL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 )

Policy contract number

A-0896

Policy instance

Insurance contract or identification number	A-0896
Number of Individuals Covered	9255
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $81,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,874

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

Policy contract number

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	1224
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Other welfare benefits provided	LIFE-VOL
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

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	744
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Other welfare benefits provided	LIFE-SDEP
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

681766G

Policy instance

Insurance contract or identification number	681766G
Number of Individuals Covered	7206
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Other welfare benefits provided	LIFE-BTRM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GF383051013601

Policy instance

Insurance contract or identification number	GF383051013601
Number of Individuals Covered	957
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $63,270
Total amount of fees paid to insurance company	USD $11,820
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $925,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,270
Amount paid for insurance broker fees	11820
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GD383051013601

Policy instance

Insurance contract or identification number	GD383051013601
Number of Individuals Covered	6539
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $108,300
Total amount of fees paid to insurance company	USD $13,284
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,566,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108,300
Amount paid for insurance broker fees	13284
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

SA383051013601

Policy instance

Insurance contract or identification number	SA383051013601
Number of Individuals Covered	6539
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $86,090
Total amount of fees paid to insurance company	USD $15,936
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC AD&D OPTION LIFE OPTION AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,260,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86,090
Amount paid for insurance broker fees	15936
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

AETNA GLOBAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

029944001100099

Policy instance

Insurance contract or identification number	029944001100099
Number of Individuals Covered	64
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	AGB WORLDTRAVELER
Welfare Benefit Premiums Paid to Carrier	USD $1,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	824
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $58,758
Total amount of fees paid to insurance company	USD $5,543
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $220,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,758
Insurance broker organization code?	3
Amount paid for insurance broker fees	5543
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	4431
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	8482
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	8482
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	8482
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $30,752
Total amount of fees paid to insurance company	USD $1,020
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $151,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,752
Amount paid for insurance broker fees	1020
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

4055340010SSLS

Policy instance

Insurance contract or identification number	4055340010SSLS
Number of Individuals Covered	4431
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $85,193
Welfare Benefit Premiums Paid to Carrier	USD $806,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $85,193
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	8482
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $186,179
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $186,179
Insurance broker organization code?	3

CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 )

Policy contract number

A-0896

Policy instance

Insurance contract or identification number	A-0896
Number of Individuals Covered	8482
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $75,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75,512

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	786
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $51,768
Total amount of fees paid to insurance company	USD $4,290
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $164,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,768
Insurance broker organization code?	3
Amount paid for insurance broker fees	4290
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	679
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $64,989
Total amount of fees paid to insurance company	USD $4,171
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $108,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,989
Insurance broker organization code?	3
Amount paid for insurance broker fees	2303
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	7251
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $190,026
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $190,026
Insurance broker organization code?	3

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	7251
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	7251
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	3695
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

G1736

Policy instance

Insurance contract or identification number	G1736
Number of Individuals Covered	675
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $55,553
Total amount of fees paid to insurance company	USD $5,366
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $138,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,553
Insurance broker organization code?	3
Amount paid for insurance broker fees	2962
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

AETNA GLOBAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

029944001100099

Policy instance

Insurance contract or identification number	029944001100099
Number of Individuals Covered	86
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $931
Other welfare benefits provided	AGB WORLDTRAVELER
Welfare Benefit Premiums Paid to Carrier	USD $5,206
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $931
Insurance broker organization code?	3

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GF383051013601

Policy instance

Insurance contract or identification number	GF383051013601
Number of Individuals Covered	880
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $70,669
Total amount of fees paid to insurance company	USD $16,893
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $869,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,669
Amount paid for insurance broker fees	16893
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GD383051013601

Policy instance

Insurance contract or identification number	GD383051013601
Number of Individuals Covered	5484
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $107,346
Total amount of fees paid to insurance company	USD $17,801
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,345,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $107,346
Amount paid for insurance broker fees	17801
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 )

Policy contract number

A-0896

Policy instance

Insurance contract or identification number	A-0896
Number of Individuals Covered	7251
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $73,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73,207

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

4055340010SSLS

Policy instance

Insurance contract or identification number	4055340010SSLS
Number of Individuals Covered	3695
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $153,421
Welfare Benefit Premiums Paid to Carrier	USD $1,022,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $153,421
Insurance broker organization code?	3

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	7251
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $29,056
Total amount of fees paid to insurance company	USD $1,042
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,056
Amount paid for insurance broker fees	1042
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

SA383051013601

Policy instance

Insurance contract or identification number	SA383051013601
Number of Individuals Covered	5484
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $89,410
Total amount of fees paid to insurance company	USD $20,886
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC AD&D OPTION LIFE OPTION AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,115,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $89,410
Amount paid for insurance broker fees	20886
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-6854-17

Policy instance

Insurance contract or identification number	4EL-6854-17
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $279
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 )

Policy contract number

A0896

Policy instance

Insurance contract or identification number	A0896
Insurance policy start date	2018-01-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

PL3-830-510136-

Policy instance

Insurance contract or identification number	PL3-830-510136-
Number of Individuals Covered	193
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NY PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $1,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

405534 0010 SSL

Policy instance

Insurance contract or identification number	405534 0010 SSL
Number of Individuals Covered	3207
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $116,955
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $779,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	6576
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA GLOBAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

0299440-011-000

Policy instance

Insurance contract or identification number	0299440-011-000
Number of Individuals Covered	1
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $150
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AGB WORLDTRAVELER
Welfare Benefit Premiums Paid to Carrier	USD $2,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	3629
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
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
Welfare Benefit Premiums Paid to Carrier	USD $64,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000006507

Policy instance

Insurance contract or identification number	0000006507
Number of Individuals Covered	1274
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $87,979
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $393,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GS3-830-510136-

Policy instance

Insurance contract or identification number	GS3-830-510136-
Number of Individuals Covered	193
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $291
Other welfare benefits provided	NY DBL STATUTORY
Welfare Benefit Premiums Paid to Carrier	USD $18,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

SA3-830-510136-

Policy instance

Insurance contract or identification number	SA3-830-510136-
Number of Individuals Covered	4453
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $68,923
Total amount of fees paid to insurance company	USD $17,767
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC AD&D OPTION LIFE OPTION AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,016,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GF3-830-510136-

Policy instance

Insurance contract or identification number	GF3-830-510136-
Number of Individuals Covered	847
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $58,363
Total amount of fees paid to insurance company	USD $15,027
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $858,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	6577
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $33,718
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GD3-830-510136-

Policy instance

Insurance contract or identification number	GD3-830-510136-
Number of Individuals Covered	4453
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $79,922
Total amount of fees paid to insurance company	USD $21,071
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,171,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

153431

Policy instance

Insurance contract or identification number	153431
Number of Individuals Covered	6577
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $164,246
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	3228
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $25,345
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $107,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-6490-14

Policy instance

Insurance contract or identification number	4EL-6490-14
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,047
Total amount of fees paid to insurance company	USD $279
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,047
Insurance broker organization code?	3
Amount paid for insurance broker fees	279
Insurance broker name	INDEPENDENCE BLUE CROSS

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GD3-830-510136-

Policy instance

Insurance contract or identification number	GD3-830-510136-
Number of Individuals Covered	2741
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $69,835
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $944,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,835
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GF3-830-510136-

Policy instance

Insurance contract or identification number	GF3-830-510136-
Number of Individuals Covered	769
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $56,760
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $760,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,760
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

SA3-830-510136-

Policy instance

Insurance contract or identification number	SA3-830-510136-
Number of Individuals Covered	2742
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $60,521
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC AD&D OPTION LIFE OPTION AD&A
Welfare Benefit Premiums Paid to Carrier	USD $814,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,521
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000006507

Policy instance

Insurance contract or identification number	0000006507
Number of Individuals Covered	975
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $57,795
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $310,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,795
Insurance broker organization code?	3
Insurance broker name	VARIOUS - SEE ATTACHED

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	2099
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
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
Welfare Benefit Premiums Paid to Carrier	USD $37,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	3307
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	3307
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $32,394
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,394
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	3307
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $123,096
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $123,096
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

405534 0010

Policy instance

Insurance contract or identification number	405534 0010
Number of Individuals Covered	2239
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $63,658
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $424,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,658
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	2099
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $20,664
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $83,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,664
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GS3-830-510136-

Policy instance

Insurance contract or identification number	GS3-830-510136-
Number of Individuals Covered	85
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	NY DBL STATUTORY
Welfare Benefit Premiums Paid to Carrier	USD $8,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	2135
Insurance policy start date	2014-04-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $6,449
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,449
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

4EL-6490-14

Policy instance

Insurance contract or identification number	4EL-6490-14
Insurance policy start date	2015-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $2,094
Total amount of fees paid to insurance company	USD $558
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,094
Insurance broker organization code?	3
Amount paid for insurance broker fees	558
Insurance broker name	INDEPENDENCE BLUE CROSS

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GD3-830-510136-

Policy instance

Insurance contract or identification number	GD3-830-510136-
Number of Individuals Covered	2244
Insurance policy start date	2014-06-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $45,065
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $673,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,065
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	793
Insurance policy start date	2014-04-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $5,524
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,524
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

SA3-830-510136-

Policy instance

Insurance contract or identification number	SA3-830-510136-
Number of Individuals Covered	2329
Insurance policy start date	2014-06-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $40,051
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC AD&D OPTION LIFE OPTION AD&A
Welfare Benefit Premiums Paid to Carrier	USD $596,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,051
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000006507

Policy instance

Insurance contract or identification number	0000006507
Number of Individuals Covered	801
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $47,798
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $295,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,798
Insurance broker organization code?	3
Insurance broker name	VARIOUS - SEE ATTACHED

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	2135
Insurance policy start date	2014-04-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $5,322
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,322
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )

Policy contract number

GF3-830-510136-

Policy instance

Insurance contract or identification number	GF3-830-510136-
Number of Individuals Covered	730
Insurance policy start date	2014-06-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $40,865
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $607,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,865
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	2099
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	1999
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $16,902
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $105,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,902
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-010340-000

Policy instance

Insurance contract or identification number	16-010340-000
Number of Individuals Covered	1811
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $55,993
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $373,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,993
Insurance broker organization code?	3
Insurance broker name	TRINICORE COMPANY INC

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4913
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $134,538
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $121,084
Insurance broker organization code?	3
Insurance broker name	EMERSON REID DBA TRA BENEFIT

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4913
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker name

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4913
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker name

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	1999
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $16,359
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,359
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-010340-000

Policy instance

Insurance contract or identification number	16-010340-000
Number of Individuals Covered	1908
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $60,092
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $400,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $60,092
Insurance broker organization code?	3
Insurance broker name	TRINICORE COMPANY INC

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	5041
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $104,538
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $104,538
Insurance broker organization code?	3
Insurance broker name	EMERSON REID DBA TRA BENEFIT

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	5041
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker name

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	5041
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	2020
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $62,396
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,396
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTDI0

Policy instance

Insurance contract or identification number	CTDI0
Number of Individuals Covered	2099
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000006507

Policy instance

Insurance contract or identification number	0000006507
Number of Individuals Covered	667
Insurance policy start date	2013-07-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $53,236
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,236
Insurance broker organization code?	3
Insurance broker name	VARIOUS - SEE ATTACHED

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTTD0-001

Policy instance

Insurance contract or identification number	CTTD0-001
Number of Individuals Covered	2099
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker name

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	781
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $67,327
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,327
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	2020
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $70,936
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,936
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000006507

Policy instance

Insurance contract or identification number	0000006507
Number of Individuals Covered	634
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $46,721
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	CRITICAL ILLNESS & ACCIDENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	VARIOUS - SEE ATTACHED

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	1884
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $71,189
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $71,189
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	794
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $71,405
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $71,405
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	1884
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $61,757
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,757
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4297
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4297
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4432
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $122,718
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $122,718
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-010340-000

Policy instance

Insurance contract or identification number	16-010340-000
Number of Individuals Covered	1756
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $69,617
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $464,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $69,617
Insurance broker organization code?	3
Insurance broker name	TRINICORE COMPANY INC

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTDI0

Policy instance

Insurance contract or identification number	CTDI0
Number of Individuals Covered	2067
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	1780
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $16,523
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,523
Insurance broker organization code?	3
Insurance broker name	THE TRINICORE COMPANY

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	1667
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $15,376
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-010340-00

Policy instance

Insurance contract or identification number	16-010340-00
Number of Individuals Covered	1678
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $69,681
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $464,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4182
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTDI0

Policy instance

Insurance contract or identification number	CTDI0
Number of Individuals Covered	1904
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	822
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $64,687
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	1820
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $66,478
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	1820
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $54,785
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4182
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4182
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $112,854
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

CTDI0

Policy instance

Insurance contract or identification number	CTDI0
Number of Individuals Covered	1971
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )

Policy contract number

252697-000

Policy instance

Insurance contract or identification number	252697-000
Number of Individuals Covered	4149
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $13,029
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-010340-00

Policy instance

Insurance contract or identification number	16-010340-00
Number of Individuals Covered	1711
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $69,427
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $462,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4072
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $125,010
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4072
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

104146

Policy instance

Insurance contract or identification number	104146
Number of Individuals Covered	4074
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	1860
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $48,889
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	882
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $58,043
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

646474

Policy instance

Insurance contract or identification number	646474
Number of Individuals Covered	1860
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $60,512
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	COMMUNICATIONS TEST DESIGN, INC.
Employer identification number (EIN):	232015935
NAIC Classification:	334200

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1982-10-12
Company Identification Number:	0005625606
Legal Registered Office Address:	1373 ENTERPRISE DR WEST CHESTER United States of America (USA) 19380