401k Plan data: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN plan

TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN
Plan identification number	505

TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover Severance pay Other welfare benefit cover

401k Sponsoring company profile

TRINITY HEALTH CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: TRINITY HEALTH CORPORATION

Employer identification number (EIN): 351443425

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about TRINITY HEALTH CORPORATION

Jurisdiction of Incorporation: South Dakota Secretary of State

Incorporation Date:

Company Identification Number: FN010643

More information about TRINITY HEALTH CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-01-01
505 2021-01-01
505 2020-01-01
505 2019-01-01
505 2018-01-01
505 2017-01-01 JEANETTE FRANCK
505 2016-01-01 JEANETTE FRANCK
505 2015-01-01 TRINITY HEALTH
505 2014-01-01 TRINITY HEALTH
505 2013-01-01 TRINITY HEALTH
505 2012-01-01 TRINITY HEALTH
505 2011-01-01 TRINITY HEALTH
505 2010-01-01 TRINITY HEALTH
505 2009-01-01 TRINITY HEALTH

Plan Statistics for TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN

401k plan membership statisitcs for TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN

Measure Date Value
2022: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 159,720
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 154,192
Number of retired or separated participants receiving benefits 2022-01-01 46
Total of all active and inactive participants 2022-01-01 154,238
2021: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 169,684
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 158,500
Number of retired or separated participants receiving benefits 2021-01-01 1,220
Total of all active and inactive participants 2021-01-01 159,720
2020: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 191,201
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 166,463
Number of retired or separated participants receiving benefits 2020-01-01 3,221
Total of all active and inactive participants 2020-01-01 169,684
2019: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 171,970
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 190,898
Number of other retired or separated participants entitled to future benefits 2019-01-01 303
Total of all active and inactive participants 2019-01-01 191,201
2018: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 169,133
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 171,820
Number of other retired or separated participants entitled to future benefits 2018-01-01 150
Total of all active and inactive participants 2018-01-01 171,970
2017: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 125,441
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 169,133
Total of all active and inactive participants 2017-01-01 169,133
Total participants 2017-01-01 169,133
2016: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 54,955
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 125,441
Total of all active and inactive participants 2016-01-01 125,441
Total participants 2016-01-01 125,441
2015: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 55,578
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 54,955
Total of all active and inactive participants 2015-01-01 54,955
Total participants 2015-01-01 54,955
2014: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 54,291
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 55,578
Total of all active and inactive participants 2014-01-01 55,578
Total participants 2014-01-01 55,578
2013: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 53,700
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 54,291
Total of all active and inactive participants 2013-01-01 54,291
Total participants 2013-01-01 54,291
2012: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 52,744
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 53,700
Total of all active and inactive participants 2012-01-01 53,700
Total participants 2012-01-01 53,700
2011: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 46,902
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 52,744
Total of all active and inactive participants 2011-01-01 52,744
Total participants 2011-01-01 52,744
2010: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 48,611
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 46,902
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 46,902
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 46,902
Number of participants with account balances 2010-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 47,767
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 44,257
Number of retired or separated participants receiving benefits 2009-01-01 4,354
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 48,611
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 48,611
Number of participants with account balances 2009-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	159,720
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	154,192
Number of retired or separated participants receiving benefits	2022-01-01	46
Total of all active and inactive participants	2022-01-01	154,238
2021: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	169,684
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	158,500
Number of retired or separated participants receiving benefits	2021-01-01	1,220
Total of all active and inactive participants	2021-01-01	159,720
2020: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	191,201
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	166,463
Number of retired or separated participants receiving benefits	2020-01-01	3,221
Total of all active and inactive participants	2020-01-01	169,684
2019: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	171,970
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	190,898
Number of other retired or separated participants entitled to future benefits	2019-01-01	303
Total of all active and inactive participants	2019-01-01	191,201
2018: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	169,133
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	171,820
Number of other retired or separated participants entitled to future benefits	2018-01-01	150
Total of all active and inactive participants	2018-01-01	171,970
2017: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	125,441
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	169,133
Total of all active and inactive participants	2017-01-01	169,133
Total participants	2017-01-01	169,133
2016: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	54,955
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	125,441
Total of all active and inactive participants	2016-01-01	125,441
Total participants	2016-01-01	125,441
2015: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	55,578
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	54,955
Total of all active and inactive participants	2015-01-01	54,955
Total participants	2015-01-01	54,955
2014: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	54,291
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	55,578
Total of all active and inactive participants	2014-01-01	55,578
Total participants	2014-01-01	55,578
2013: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	53,700
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	54,291
Total of all active and inactive participants	2013-01-01	54,291
Total participants	2013-01-01	54,291
2012: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	52,744
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	53,700
Total of all active and inactive participants	2012-01-01	53,700
Total participants	2012-01-01	53,700
2011: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	46,902
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	52,744
Total of all active and inactive participants	2011-01-01	52,744
Total participants	2011-01-01	52,744
2010: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	48,611
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	46,902
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	46,902
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	46,902
Number of participants with account balances	2010-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	47,767
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	44,257
Number of retired or separated participants receiving benefits	2009-01-01	4,354
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	48,611
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	48,611
Number of participants with account balances	2009-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Form 5500 Responses for TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN

2022: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Mulitple employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Mulitple employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Mulitple employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Mulitple employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Mulitple employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Multi-employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

696981GRH

Policy instance

Insurance contract or identification number	696981GRH
Number of Individuals Covered	1018
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $489,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

EXL SAHIV 10519

Policy instance

Insurance contract or identification number	EXL SAHIV 10519
Number of Individuals Covered	295
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $923
Other welfare benefits provided	HIV INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $7,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $568
Insurance broker organization code?	3

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	9341
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $84,350
Total amount of fees paid to insurance company	USD $31,439
Other welfare benefits provided	VOLUNTARY LEGAL PLAN
Welfare Benefit Premiums Paid to Carrier	USD $1,669,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $84,350
Amount paid for insurance broker fees	6543
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

717490

Policy instance

Insurance contract or identification number	717490
Number of Individuals Covered	148036
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,721,986
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

402914G

Policy instance

Insurance contract or identification number	402914G
Number of Individuals Covered	136675
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,225,232
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

723912D

Policy instance

Insurance contract or identification number	723912D
Number of Individuals Covered	15377
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	NY PD FAMILY LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $6,840,546
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

406310L

Policy instance

Insurance contract or identification number	406310L
Number of Individuals Covered	2251
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	MASS PD FAMILY AND MEDICAL LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $1,474,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	165275
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,301,391
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

ADD-SO8231

Policy instance

Insurance contract or identification number	ADD-SO8231
Number of Individuals Covered	24399
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,976,987
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

696981GLT

Policy instance

Insurance contract or identification number	696981GLT
Number of Individuals Covered	87754
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,482,092
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

696981GLT

Policy instance

Insurance contract or identification number	696981GLT
Number of Individuals Covered	91706
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,032,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	10931
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $97,235
Total amount of fees paid to insurance company	USD $45,781
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,608,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $97,235
Insurance broker organization code?	3
Amount paid for insurance broker fees	27727
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717490

Policy instance

Insurance contract or identification number	0717490
Number of Individuals Covered	149593
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,207,375
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

402914G

Policy instance

Insurance contract or identification number	402914G
Number of Individuals Covered	134432
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,573,551
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

696981GRH

Policy instance

Insurance contract or identification number	696981GRH
Number of Individuals Covered	2229
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $699,805
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

723912D

Policy instance

Insurance contract or identification number	723912D
Number of Individuals Covered	15583
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	NEW YORK TAX
Welfare Benefit Premiums Paid to Carrier	USD $5,999,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	166348
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,292,985
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

ADD S08231

Policy instance

Insurance contract or identification number	ADD S08231
Number of Individuals Covered	25713
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,123,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

EXLSAHIV100519

Policy instance

Insurance contract or identification number	EXLSAHIV100519
Number of Individuals Covered	329
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,225
Other welfare benefits provided	HIV INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $9,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $754
Insurance broker organization code?	3

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

Policy contract number

406310L

Policy instance

Insurance contract or identification number	406310L
Number of Individuals Covered	3332
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STATE OF MASS. PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $1,345,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

EXLSAHIV100519

Policy instance

Insurance contract or identification number	EXLSAHIV100519
Number of Individuals Covered	472
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,637
Other welfare benefits provided	HIV INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $12,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,008
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717490

Policy instance

Insurance contract or identification number	0717490
Number of Individuals Covered	146510
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,284,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	13168
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $115,557
Total amount of fees paid to insurance company	USD $43,420
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,649,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,640
Insurance broker organization code?	3
Amount paid for insurance broker fees	30188
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

696981GRH

Policy instance

Insurance contract or identification number	696981GRH
Number of Individuals Covered	3400
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $993,409
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

723912D

Policy instance

Insurance contract or identification number	723912D
Number of Individuals Covered	15735
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	NEW YORK PAID FAMILY LEAVE
Welfare Benefit Premiums Paid to Carrier	USD $5,322,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	161770
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,231,579
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

ADD-S08231

Policy instance

Insurance contract or identification number	ADD-S08231
Number of Individuals Covered	27964
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,141,016
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

696981GLT

Policy instance

Insurance contract or identification number	696981GLT
Number of Individuals Covered	93856
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,160,959
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

402914G

Policy instance

Insurance contract or identification number	402914G
Number of Individuals Covered	146538
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,944,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	172305
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,186,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SIRIUS AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38776 )

Policy contract number

EXLSAHIV100519

Policy instance

Insurance contract or identification number	EXLSAHIV100519
Number of Individuals Covered	525
Insurance policy start date	2019-04-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $876
Other welfare benefits provided	HIV INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $6,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $539
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3

BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )

Policy contract number

BCSHIV000110

Policy instance

Insurance contract or identification number	BCSHIV000110
Number of Individuals Covered	410
Insurance policy start date	2019-01-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $327
Other welfare benefits provided	HIV INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $2,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $201
Additional information about fees paid to insurance broker	BROKER COMMISSIONS
Insurance broker organization code?	3

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

Policy contract number

696981GLT

Policy instance

Insurance contract or identification number	696981GLT
Number of Individuals Covered	105597
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,138,149
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

ADD-S08231

Policy instance

Insurance contract or identification number	ADD-S08231
Number of Individuals Covered	28084
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,911,664
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

723912D

Policy instance

Insurance contract or identification number	723912D
Number of Individuals Covered	17275
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	NEW YORK TAX
Welfare Benefit Premiums Paid to Carrier	USD $3,900,213
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

696981GRH

Policy instance

Insurance contract or identification number	696981GRH
Number of Individuals Covered	6446
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,604,431
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

402914G

Policy instance

Insurance contract or identification number	402914G
Number of Individuals Covered	150002
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,801,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	14918
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $50,468
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $2,241,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,468
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

717490

Policy instance

Insurance contract or identification number	717490
Number of Individuals Covered	72017
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,921,286
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

696981GRH

Policy instance

Insurance contract or identification number	696981GRH
Number of Individuals Covered	5689
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $40,369
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,685,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	40369
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010044210

Policy instance

Insurance contract or identification number	000010044210
Number of Individuals Covered	411
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,968
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $394,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,968
Insurance broker organization code?	3

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

Policy contract number

696981GLT

Policy instance

Insurance contract or identification number	696981GLT
Number of Individuals Covered	86593
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $328,395
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,582,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	328395
Insurance broker organization code?	3

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

Policy contract number

ADD-S08231

Policy instance

Insurance contract or identification number	ADD-S08231
Number of Individuals Covered	26852
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $7,745
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,060,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7745
Insurance broker organization code?	3

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

Policy contract number

402914G

Policy instance

Insurance contract or identification number	402914G
Number of Individuals Covered	128616
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $324,798
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,130,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	324798
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 008032

Policy instance

Insurance contract or identification number	LK 008032
Number of Individuals Covered	1037
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,606
Total amount of fees paid to insurance company	USD $1,417
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,606
Amount paid for insurance broker fees	1417
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

389018 0001

Policy instance

Insurance contract or identification number	389018 0001
Number of Individuals Covered	6
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $20,252
Total amount of fees paid to insurance company	USD $6,370
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,309,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,582
Amount paid for insurance broker fees	6370
Insurance broker organization code?	3

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	150944
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,107,580
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

145416

Policy instance

Insurance contract or identification number	145416
Number of Individuals Covered	138
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,152
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,907
Insurance broker organization code?	3

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	14212
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $2,469,463
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

723912D

Policy instance

Insurance contract or identification number	723912D
Number of Individuals Covered	17183
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	NEW YORK TAX
Welfare Benefit Premiums Paid to Carrier	USD $3,639,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

717490

Policy instance

Insurance contract or identification number	717490
Number of Individuals Covered	70583
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,306,707
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

402914

Policy instance

Insurance contract or identification number	402914
Number of Individuals Covered	180373
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $531,710
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,575,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	531710
Insurance broker name	SAUL LOCKER

BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 )

Policy contract number

00000

Policy instance

Insurance contract or identification number	00000
Number of Individuals Covered	415
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,168
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $719
Insurance broker organization code?	4
Insurance broker name	MHA INSURANCE AGENCY

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

224429

Policy instance

Insurance contract or identification number	224429
Number of Individuals Covered	9645
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $32,243
Total amount of fees paid to insurance company	USD $56,486
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,824,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,243
Amount paid for insurance broker fees	56486
Insurance broker organization code?	3
Insurance broker name	EMPLOYEE FAMILY PROTECTION

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

819782

Policy instance

Insurance contract or identification number	819782
Number of Individuals Covered	1851
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $23,758
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,362,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,758
Insurance broker organization code?	3
Insurance broker name	ONEGROUP NY INC

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	12492
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,905,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

717490

Policy instance

Insurance contract or identification number	717490
Number of Individuals Covered	66820
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,828,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10044210

Policy instance

Insurance contract or identification number	10044210
Number of Individuals Covered	381
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,601
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $402,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,601
Insurance broker organization code?	3
Insurance broker name	ACRISURE LLC

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

Policy contract number

696981G

Policy instance

Insurance contract or identification number	696981G
Number of Individuals Covered	82308
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $724,336
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,300,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	724336
Insurance broker organization code?	3
Insurance broker name	SAUL LOCKER

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

Policy contract number

696981GRH

Policy instance

Insurance contract or identification number	696981GRH
Number of Individuals Covered	2827
Total amount of fees paid to insurance company	USD $33,966
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,729,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	33966
Insurance broker organization code?	3
Insurance broker name	SAUL LOCKER

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

Policy contract number

14546

Policy instance

Insurance contract or identification number	14546
Number of Individuals Covered	131
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,208
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,954
Insurance broker name	MAY BONEE AND COMPANY INC

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00000

Policy instance

Insurance contract or identification number	00000
Number of Individuals Covered	133043
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $1,053,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

100086

Policy instance

Insurance contract or identification number	100086
Number of Individuals Covered	99
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

389018

Policy instance

Insurance contract or identification number	389018
Number of Individuals Covered	4138
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $18,480
Total amount of fees paid to insurance company	USD $5,540
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,331,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,622
Amount paid for insurance broker fees	5540
Insurance broker organization code?	3
Insurance broker name	BENEFIT ADVISORS NETWORK

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

819783

Policy instance

Insurance contract or identification number	819783
Number of Individuals Covered	4770
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,500
Other welfare benefits provided	DISABILITY BENEFITS LAW
Welfare Benefit Premiums Paid to Carrier	USD $602,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,500
Insurance broker name	ONEGROUP NY INC.

SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

82311

Policy instance

Insurance contract or identification number	82311
Number of Individuals Covered	475
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $82,334
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $340,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,334
Insurance broker organization code?	3
Insurance broker name	ONE GROUP

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

Policy contract number

ADDS08231

Policy instance

Insurance contract or identification number	ADDS08231
Number of Individuals Covered	24989
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,845,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	SAUL LOCKER

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

513188

Policy instance

Insurance contract or identification number	513188
Number of Individuals Covered	459
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $67,528
Total amount of fees paid to insurance company	USD $16,882
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,350,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $67,528
Amount paid for insurance broker fees	16882
Insurance broker organization code?	3
Insurance broker name	WILSHIRE BENEFITS GROUP

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

468186

Policy instance

Insurance contract or identification number	468186
Number of Individuals Covered	317
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,113
Total amount of fees paid to insurance company	USD $328
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,113
Amount paid for insurance broker fees	328
Insurance broker organization code?	3
Insurance broker name	CM SMITH AGENCY

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

468187

Policy instance

Insurance contract or identification number	468187
Number of Individuals Covered	289
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,207
Total amount of fees paid to insurance company	USD $4,870
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,207
Amount paid for insurance broker fees	4870
Insurance broker organization code?	3
Insurance broker name	CM SMITH AGENCY

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

508451

Policy instance

Insurance contract or identification number	508451
Number of Individuals Covered	54955
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $121,210
Total amount of fees paid to insurance company	USD $266,073
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,598,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $121,210
Insurance broker organization code?	3
Amount paid for insurance broker fees	1687
Insurance broker name	HEALTHTRUCT PURCHASING GROUP

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

Policy contract number

696981G

Policy instance

Insurance contract or identification number	696981G
Number of Individuals Covered	57018
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $244,350
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,865,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,750
Insurance broker organization code?	3
Insurance broker name	LOCKER SAUL

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10044210

Policy instance

Insurance contract or identification number	10044210
Number of Individuals Covered	316
Total amount of commissions paid to insurance broker	USD $4,912
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $287,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,912
Insurance broker organization code?	3
Insurance broker name	ACRISURE LLC

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	10299
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Welfare Benefit Premiums Paid to Carrier	USD $1,717,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

36454

Policy instance

Insurance contract or identification number	36454
Number of Individuals Covered	42728
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,303,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0473463

Policy instance

Insurance contract or identification number	0473463
Number of Individuals Covered	1080
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $40,704
Total amount of fees paid to insurance company	USD $1,105
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $354,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,704
Amount paid for insurance broker fees	1105
Insurance broker organization code?	3
Insurance broker name	MESIROW INSURANCE SERVICES INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00000107

Policy instance

Insurance contract or identification number	00000107
Number of Individuals Covered	5147
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

50845

Policy instance

Insurance contract or identification number	50845
Number of Individuals Covered	55578
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $136,616
Total amount of fees paid to insurance company	USD $6,106
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,001,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $136,616
Insurance broker organization code?	3
Amount paid for insurance broker fees	6106
Insurance broker name	COMPSYCH

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10044210

Policy instance

Insurance contract or identification number	10044210
Number of Individuals Covered	279
Total amount of commissions paid to insurance broker	USD $9,526
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $309,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,526
Insurance broker organization code?	3
Insurance broker name	ACRISURE LLC

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	9295
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Other welfare benefits provided	PRE-PAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $2,227,188
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

696981G

Policy instance

Insurance contract or identification number	696981G
Number of Individuals Covered	66252
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $215,015
Total amount of fees paid to insurance company	USD $48,750
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,375,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $215,015
Amount paid for insurance broker fees	48750
Insurance broker organization code?	3
Insurance broker name	ALEXANDER BENEFITS CONSULTING LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717490

Policy instance

Insurance contract or identification number	0717490
Number of Individuals Covered	35575
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,302,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	8748
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Other welfare benefits provided	PRE-PAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,768,498
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

696981G

Policy instance

Insurance contract or identification number	696981G
Number of Individuals Covered	47774
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $225,662
Total amount of fees paid to insurance company	USD $48,750
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,641,289
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $225,662
Amount paid for insurance broker fees	48750
Insurance broker organization code?	3
Insurance broker name	ALEXANDER BENEFITS CONSULTING LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10044210

Policy instance

Insurance contract or identification number	10044210
Number of Individuals Covered	247
Total amount of commissions paid to insurance broker	USD $5,881
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $262,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,881
Insurance broker organization code?	3
Insurance broker name	ACRISURE LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

00000107

Policy instance

Insurance contract or identification number	00000107
Number of Individuals Covered	5147
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $132,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717490

Policy instance

Insurance contract or identification number	0717490
Number of Individuals Covered	34700
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,834,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

50845

Policy instance

Insurance contract or identification number	50845
Number of Individuals Covered	54291
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $22,332
Total amount of fees paid to insurance company	USD $115,223
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,166,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,332
Insurance broker organization code?	3
Amount paid for insurance broker fees	3939
Additional information about fees paid to insurance broker	PRINTING SERVICES
Insurance broker name	COMPSYCH

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

50845

Policy instance

Insurance contract or identification number	50845
Number of Individuals Covered	52744
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $9,540,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $113,437
Additional information about fees paid to insurance broker	SALES AND SERVICE COMPENSATION AND COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	2935
Insurance broker name	HARVARD PRINTING GROUP

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

Policy contract number

696981G

Policy instance

Insurance contract or identification number	696981G
Number of Individuals Covered	36588
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,768,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	267203
Insurance broker organization code?	3
Insurance broker name	ALEXANDER BENEFITS CONSULTING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

503126

Policy instance

Insurance contract or identification number	503126
Number of Individuals Covered	6869
Insurance policy start date	2012-01-01
Insurance policy end date	2012-03-31
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,246,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $161,231
Insurance broker organization code?	3
Insurance broker name	PHASE IV LTD

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10044210

Policy instance

Insurance contract or identification number	10044210
Number of Individuals Covered	220
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,972
Insurance broker organization code?	3
Insurance broker name	ACRISURE LLC

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	7413
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,204,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717490

Policy instance

Insurance contract or identification number	0717490
Number of Individuals Covered	29246
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,732,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

503126

Policy instance

Insurance contract or identification number	503126
Number of Individuals Covered	6869
Insurance policy start date	2011-01-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $163,792
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,246,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

50845

Policy instance

Insurance contract or identification number	50845
Number of Individuals Covered	52744
Total amount of commissions paid to insurance broker	USD $113,437
Total amount of fees paid to insurance company	USD $2,935
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $9,540,461

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	7413
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,204,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717490

Policy instance

Insurance contract or identification number	0717490
Number of Individuals Covered	29246
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,732,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0105068

Policy instance

Insurance contract or identification number	0105068
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for group deferred annuity?	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10044210

Policy instance

Insurance contract or identification number	10044210
Number of Individuals Covered	220
Total amount of commissions paid to insurance broker	USD $9,972
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,774
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

696981G

Policy instance

Insurance contract or identification number	696981G
Number of Individuals Covered	36588
Total amount of fees paid to insurance company	USD $267,203
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,768,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0717490

Policy instance

Insurance contract or identification number	0717490
Number of Individuals Covered	27502
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,389,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10044210

Policy instance

Insurance contract or identification number	10044210
Number of Individuals Covered	131
Total amount of commissions paid to insurance broker	USD $7,864
Total amount of fees paid to insurance company	USD $3,547
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,109
Insurance broker organization code?	3
Amount paid for insurance broker fees	3547
Insurance broker name	CAMPBELL FINANCIAL BENEFITS, INC.

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0105068

Policy instance

Insurance contract or identification number	0105068
Number of Individuals Covered	82727
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $572,703
Total amount of fees paid to insurance company	USD $103,859
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,538,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $572,703
Amount paid for insurance broker fees	103859
Insurance broker organization code?	3
Insurance broker name	SAUL LOCKER

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

503126

Policy instance

Insurance contract or identification number	503126
Number of Individuals Covered	42269
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $613,109
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,268,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $613,109
Insurance broker organization code?	3
Insurance broker name	ALEXANDER BENEFITS CONSULTING

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2420010

Policy instance

Insurance contract or identification number	2420010
Number of Individuals Covered	6764
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Other welfare benefits provided	PREPAID LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $1,088,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TRINITY HEALTH CORPORATION
Employer identification number (EIN):	351443425
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	South Dakota Secretary of State
Incorporation Date:
Company Identification Number:	FN010643