SEIU LOCAL 73 MIDWEST BENEFITS FUND 401k Plan overview

Plan Name	SEIU LOCAL 73 MIDWEST BENEFITS FUND
Plan identification number	501

SEIU LOCAL 73 MIDWEST BENEFITS FUND Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

TRUSTEES OF SEIU LOCAL 73 MIDWEST BENEFITS FUND has sponsored the creation of one or more 401k plans.

Company Name:	TRUSTEES OF SEIU LOCAL 73 MIDWEST BENEFITS FUND
Employer identification number (EIN):	356065091
NAIC Classification:	561900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SEIU LOCAL 73 MIDWEST BENEFITS FUND

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-01-01
501	2017-01-01
501	2016-01-01	MARY ANN COLLINS
501	2015-01-01	MARY ANN COLLINS
501	2014-01-01	MATTHEW BRANDON
501	2013-01-01	MATTHEW BRANDON
501	2012-01-01	MATTHEW BRANDON
501	2011-01-01	MATTHEW BRANDON
501	2010-01-01	MATTHEW BRANDON
501	2009-01-01	JOHN SANEW

Plan Statistics for SEIU LOCAL 73 MIDWEST BENEFITS FUND

401k plan membership statisitcs for SEIU LOCAL 73 MIDWEST BENEFITS FUND

Measure	Date	Value
2018: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2018 401k membership
Total participants, beginning-of-year	2018-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Number of employers contributing to the scheme	2018-01-01	0
2017: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,968
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Number of employers contributing to the scheme	2017-01-01	15
2016: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2016 401k membership
Total participants, beginning-of-year	2016-01-01	2,131
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,718
Number of retired or separated participants receiving benefits	2016-01-01	183
Number of other retired or separated participants entitled to future benefits	2016-01-01	67
Total of all active and inactive participants	2016-01-01	1,968
Number of employers contributing to the scheme	2016-01-01	17
2015: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2,346
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,838
Number of retired or separated participants receiving benefits	2015-01-01	201
Number of other retired or separated participants entitled to future benefits	2015-01-01	92
Total of all active and inactive participants	2015-01-01	2,131
Number of employers contributing to the scheme	2015-01-01	18
2014: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,346
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2,052
Number of retired or separated participants receiving benefits	2014-01-01	206
Number of other retired or separated participants entitled to future benefits	2014-01-01	88
Total of all active and inactive participants	2014-01-01	2,346
Number of employers contributing to the scheme	2014-01-01	33
2013: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,468
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,180
Number of retired or separated participants receiving benefits	2013-01-01	46
Number of other retired or separated participants entitled to future benefits	2013-01-01	120
Total of all active and inactive participants	2013-01-01	2,346
2012: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,627
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2,291
Number of retired or separated participants receiving benefits	2012-01-01	57
Number of other retired or separated participants entitled to future benefits	2012-01-01	120
Total of all active and inactive participants	2012-01-01	2,468
2011: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,857
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2,459
Number of retired or separated participants receiving benefits	2011-01-01	17
Number of other retired or separated participants entitled to future benefits	2011-01-01	151
Total of all active and inactive participants	2011-01-01	2,627
2010: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2010 401k membership
Total participants, beginning-of-year	2010-01-01	920
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2,628
Number of retired or separated participants receiving benefits	2010-01-01	8
Number of other retired or separated participants entitled to future benefits	2010-01-01	221
Total of all active and inactive participants	2010-01-01	2,857
2009: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,133
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	688
Number of retired or separated participants receiving benefits	2009-01-01	9
Number of other retired or separated participants entitled to future benefits	2009-01-01	223
Total of all active and inactive participants	2009-01-01	920

Financial Data on SEIU LOCAL 73 MIDWEST BENEFITS FUND

Measure	Date	Value
2018 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2018 401k financial data
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$6,349,032
Total income from all sources	2018-12-31	$0
Expenses. Total of all expenses incurred	2018-12-31	$0
Total plan assets at end of year	2018-12-31	$0
Total plan assets at beginning of year	2018-12-31	$6,349,032
Value of fidelity bond covering the plan	2018-12-31	$500,000
Net income (gross income less expenses)	2018-12-31	$0
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$0
2017 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$-21,417
Total unrealized appreciation/depreciation of assets	2017-12-31	$-21,417
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$6,349,032
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$630,220
Total income from all sources (including contributions)	2017-12-31	$3,523,283
Total loss/gain on sale of assets	2017-12-31	$-20,208
Total of all expenses incurred	2017-12-31	$10,467,119
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$9,187,222
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$3,150,726
Value of total assets at end of year	2017-12-31	$6,349,032
Value of total assets at beginning of year	2017-12-31	$7,574,056
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,279,897
Total interest from all sources	2017-12-31	$71,280
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$61,337
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$61,337
Administrative expenses professional fees incurred	2017-12-31	$325,309
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$218,240
Participant contributions at end of year	2017-12-31	$5,046
Participant contributions at beginning of year	2017-12-31	$89,258
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-12-31	$3,407,992
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$50,723
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$46,313
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$5,633,637
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$82,634
Other income not declared elsewhere	2017-12-31	$171,328
Administrative expenses (other) incurred	2017-12-31	$918,278
Liabilities. Value of operating payables at end of year	2017-12-31	$637,597
Liabilities. Value of operating payables at beginning of year	2017-12-31	$3,940
Total non interest bearing cash at end of year	2017-12-31	$6,090,659
Total non interest bearing cash at beginning of year	2017-12-31	$459,813
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$-6,943,836
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$6,943,836
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$36,310
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,071,360
Income. Interest from US Government securities	2017-12-31	$57,555
Income. Interest from corporate debt instruments	2017-12-31	$13,725
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$3,317,594
Asset value of US Government securities at beginning of year	2017-12-31	$3,292,497
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$110,237
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$2,932,486
Employer contributions (assets) at end of year	2017-12-31	$202,604
Employer contributions (assets) at beginning of year	2017-12-31	$1,382,058
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,461,636
Asset. Corporate debt instrument preferred debt at beginning of year	2017-12-31	$115,609
Asset. Corporate debt instrument debt (other) at beginning of year	2017-12-31	$67,135
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$77,798
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$543,646
Assets. Value of buildings and other operty used in plan operation at beginning of year	2017-12-31	$50,013
Did the plan have assets held for investment	2017-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Aggregate proceeds on sale of assets	2017-12-31	$7,590,311
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$7,610,519
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	BANSLEY AND KIENER, LLP
Accountancy firm EIN	2017-12-31	362152389
2016 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$-7,717
Total unrealized appreciation/depreciation of assets	2016-12-31	$-7,717
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$630,220
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$266,205
Total income from all sources (including contributions)	2016-12-31	$5,678,812
Total loss/gain on sale of assets	2016-12-31	$-3,079
Total of all expenses incurred	2016-12-31	$5,907,902
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$5,467,660
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$5,521,129
Value of total assets at end of year	2016-12-31	$7,574,056
Value of total assets at beginning of year	2016-12-31	$7,439,131
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$440,242
Total interest from all sources	2016-12-31	$51,748
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$54,150
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$54,150
Administrative expenses professional fees incurred	2016-12-31	$45,089
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$473,244
Participant contributions at end of year	2016-12-31	$89,258
Participant contributions at beginning of year	2016-12-31	$65,854
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$62,379
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$46,313
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$58,646
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$82,634
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$9,769
Other income not declared elsewhere	2016-12-31	$1,003
Administrative expenses (other) incurred	2016-12-31	$370,225
Liabilities. Value of operating payables at end of year	2016-12-31	$3,940
Liabilities. Value of operating payables at beginning of year	2016-12-31	$7,519
Total non interest bearing cash at end of year	2016-12-31	$459,813
Total non interest bearing cash at beginning of year	2016-12-31	$168,580
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-229,090
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$6,943,836
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$7,172,926
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$24,928
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,071,360
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,932,570
Income. Interest from US Government securities	2016-12-31	$46,599
Income. Interest from corporate debt instruments	2016-12-31	$5,149
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$5,371,792
Asset value of US Government securities at end of year	2016-12-31	$3,292,497
Asset value of US Government securities at beginning of year	2016-12-31	$3,490,836
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$61,578
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$5,047,885
Employer contributions (assets) at end of year	2016-12-31	$1,382,058
Employer contributions (assets) at beginning of year	2016-12-31	$1,516,907
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$33,489
Asset. Corporate debt instrument preferred debt at end of year	2016-12-31	$115,609
Asset. Corporate debt instrument preferred debt at beginning of year	2016-12-31	$79,732
Asset. Corporate debt instrument debt (other) at end of year	2016-12-31	$67,135
Asset. Corporate debt instrument debt (other) at beginning of year	2016-12-31	$42,343
Assets. Corporate common stocks other than exployer securities at beginning of year	2016-12-31	$23,687
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$543,646
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$248,917
Assets. Value of buildings and other operty used in plan operation at end of year	2016-12-31	$50,013
Assets. Value of buildings and other operty used in plan operation at beginning of year	2016-12-31	$59,976
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Aggregate proceeds on sale of assets	2016-12-31	$4,331,795
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$4,334,874
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	BANSLEY AND KIENER, LLP
Accountancy firm EIN	2016-12-31	362152389
2015 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$-10,905
Total unrealized appreciation/depreciation of assets	2015-12-31	$-10,905
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$266,205
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$658,062
Total income from all sources (including contributions)	2015-12-31	$6,723,158
Total loss/gain on sale of assets	2015-12-31	$-938
Total of all expenses incurred	2015-12-31	$7,344,690
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$6,874,359
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$6,710,096
Value of total assets at end of year	2015-12-31	$7,439,131
Value of total assets at beginning of year	2015-12-31	$8,452,520
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$470,331
Total interest from all sources	2015-12-31	$55,283
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$25,471
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$25,180
Administrative expenses professional fees incurred	2015-12-31	$49,453
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$568,551
Participant contributions at end of year	2015-12-31	$65,854
Participant contributions at beginning of year	2015-12-31	$175,969
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$88,578
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$58,646
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$60,756
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$9,769
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$33,389
Other income not declared elsewhere	2015-12-31	$3,269
Administrative expenses (other) incurred	2015-12-31	$394,156
Liabilities. Value of operating payables at end of year	2015-12-31	$7,519
Liabilities. Value of operating payables at beginning of year	2015-12-31	$36,391
Total non interest bearing cash at end of year	2015-12-31	$168,580
Total non interest bearing cash at beginning of year	2015-12-31	$260,388
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-621,532
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$7,172,926
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$7,794,458
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$26,722
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,932,570
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,470,753
Income. Interest from US Government securities	2015-12-31	$50,735
Income. Interest from corporate debt instruments	2015-12-31	$4,548
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$16,100
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$16,100
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$6,740,710
Asset value of US Government securities at end of year	2015-12-31	$3,490,836
Asset value of US Government securities at beginning of year	2015-12-31	$4,019,055
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-59,118
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$6,141,545
Employer contributions (assets) at end of year	2015-12-31	$1,516,907
Employer contributions (assets) at beginning of year	2015-12-31	$1,240,661
Income. Dividends from common stock	2015-12-31	$291
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$45,071
Asset. Corporate debt instrument preferred debt at end of year	2015-12-31	$79,732
Asset. Corporate debt instrument preferred debt at beginning of year	2015-12-31	$80,769
Asset. Corporate debt instrument debt (other) at end of year	2015-12-31	$42,343
Asset. Corporate debt instrument debt (other) at beginning of year	2015-12-31	$43,124
Assets. Corporate common stocks other than exployer securities at end of year	2015-12-31	$23,687
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$14,531
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$248,917
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$588,282
Assets. Value of buildings and other operty used in plan operation at end of year	2015-12-31	$59,976
Assets. Value of buildings and other operty used in plan operation at beginning of year	2015-12-31	$70,414
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Aggregate proceeds on sale of assets	2015-12-31	$4,270,082
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$4,271,020
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	BANSLEY AND KIENER, LLP
Accountancy firm EIN	2015-12-31	362152389
2014 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$4,768
Total unrealized appreciation/depreciation of assets	2014-12-31	$4,768
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$658,062
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$308,773
Total income from all sources (including contributions)	2014-12-31	$7,814,393
Total loss/gain on sale of assets	2014-12-31	$-6,592
Total of all expenses incurred	2014-12-31	$7,723,864
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$7,225,750
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$7,678,963
Value of total assets at end of year	2014-12-31	$8,452,520
Value of total assets at beginning of year	2014-12-31	$8,012,702
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$498,114
Total interest from all sources	2014-12-31	$49,490
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$76,880
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$76,610
Administrative expenses professional fees incurred	2014-12-31	$47,644
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$1,244,351
Participant contributions at end of year	2014-12-31	$175,969
Participant contributions at beginning of year	2014-12-31	$103,225
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$4,166
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$390,386
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$60,756
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$112,897
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$33,389
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$9,190
Other income not declared elsewhere	2014-12-31	$2,831
Administrative expenses (other) incurred	2014-12-31	$419,812
Liabilities. Value of operating payables at end of year	2014-12-31	$36,391
Liabilities. Value of operating payables at beginning of year	2014-12-31	$8,683
Total non interest bearing cash at end of year	2014-12-31	$260,388
Total non interest bearing cash at beginning of year	2014-12-31	$449,164
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$90,529
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$7,794,458
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$7,703,929
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$30,658
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,470,753
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,494,642
Income. Interest from US Government securities	2014-12-31	$44,942
Income. Interest from corporate debt instruments	2014-12-31	$4,548
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$16,100
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$6,798,308
Asset value of US Government securities at end of year	2014-12-31	$4,019,055
Asset value of US Government securities at beginning of year	2014-12-31	$3,900,046
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$8,053
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$6,430,446
Employer contributions (assets) at end of year	2014-12-31	$1,240,661
Employer contributions (assets) at beginning of year	2014-12-31	$734,353
Income. Dividends from common stock	2014-12-31	$270
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$37,056
Asset. Corporate debt instrument preferred debt at end of year	2014-12-31	$80,769
Asset. Corporate debt instrument preferred debt at beginning of year	2014-12-31	$80,331
Asset. Corporate debt instrument debt (other) at end of year	2014-12-31	$43,124
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$42,821
Assets. Corporate common stocks other than exployer securities at end of year	2014-12-31	$14,531
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-12-31	$13,780
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$588,282
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$290,900
Assets. Value of buildings and other operty used in plan operation at end of year	2014-12-31	$70,414
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-12-31	$81,443
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$3,106,369
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$3,112,961
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	BANSLEY AND KIENER, LLP
Accountancy firm EIN	2014-12-31	362152389
2013 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$-39,935
Total unrealized appreciation/depreciation of assets	2013-12-31	$-39,935
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$308,773
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$342,667
Total income from all sources (including contributions)	2013-12-31	$7,575,789
Total loss/gain on sale of assets	2013-12-31	$-19,224
Total of all expenses incurred	2013-12-31	$7,604,277
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$7,124,762
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$7,428,977
Value of total assets at end of year	2013-12-31	$8,012,702
Value of total assets at beginning of year	2013-12-31	$8,075,084
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$479,515
Total interest from all sources	2013-12-31	$62,260
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$29,607
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$29,378
Administrative expenses professional fees incurred	2013-12-31	$49,813
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$725,000
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,211,101
Participant contributions at end of year	2013-12-31	$103,225
Participant contributions at beginning of year	2013-12-31	$106,353
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$11,415
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$102,397
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$112,897
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$97,356
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$9,190
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$38,036
Other income not declared elsewhere	2013-12-31	$5,077
Administrative expenses (other) incurred	2013-12-31	$398,251
Liabilities. Value of operating payables at end of year	2013-12-31	$8,683
Liabilities. Value of operating payables at beginning of year	2013-12-31	$7,231
Total non interest bearing cash at end of year	2013-12-31	$449,164
Total non interest bearing cash at beginning of year	2013-12-31	$436,164
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-28,488
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$7,703,929
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$7,732,417
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$31,451
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,494,642
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,958,510
Income. Interest from US Government securities	2013-12-31	$57,712
Income. Interest from corporate debt instruments	2013-12-31	$4,548
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$7,001,079
Asset value of US Government securities at end of year	2013-12-31	$3,900,046
Asset value of US Government securities at beginning of year	2013-12-31	$4,470,010
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$109,027
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$6,206,461
Employer contributions (assets) at end of year	2013-12-31	$734,353
Employer contributions (assets) at beginning of year	2013-12-31	$802,805
Income. Dividends from common stock	2013-12-31	$229
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$21,286
Asset. Corporate debt instrument preferred debt at end of year	2013-12-31	$80,331
Asset. Corporate debt instrument preferred debt at beginning of year	2013-12-31	$129,597
Asset. Corporate debt instrument debt (other) at end of year	2013-12-31	$42,821
Assets. Corporate common stocks other than exployer securities at end of year	2013-12-31	$13,780
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-12-31	$7,627
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$290,900
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$297,400
Assets. Value of buildings and other operty used in plan operation at end of year	2013-12-31	$81,443
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-12-31	$66,662
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$1,785,000
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$1,804,224
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	BANSLEY AND KIENER, LLP
Accountancy firm EIN	2013-12-31	362152389
2012 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$-5,265
Total unrealized appreciation/depreciation of assets	2012-12-31	$-5,265
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$342,667
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$442,439
Total income from all sources (including contributions)	2012-12-31	$7,949,878
Total loss/gain on sale of assets	2012-12-31	$-8,036
Total of all expenses incurred	2012-12-31	$7,888,767
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$7,355,190
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$7,784,591
Value of total assets at end of year	2012-12-31	$8,075,084
Value of total assets at beginning of year	2012-12-31	$8,113,745
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$533,577
Total interest from all sources	2012-12-31	$71,124
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$44,902
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$44,709
Administrative expenses professional fees incurred	2012-12-31	$51,570
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$725,000
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$1,238,426
Participant contributions at end of year	2012-12-31	$106,353
Participant contributions at beginning of year	2012-12-31	$81,934
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$20,743
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$82,644
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$97,356
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$104,877
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$38,036
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$57,333
Other income not declared elsewhere	2012-12-31	$3,485
Administrative expenses (other) incurred	2012-12-31	$450,743
Liabilities. Value of operating payables at end of year	2012-12-31	$7,231
Liabilities. Value of operating payables at beginning of year	2012-12-31	$20,406
Total non interest bearing cash at end of year	2012-12-31	$436,164
Total non interest bearing cash at beginning of year	2012-12-31	$1,143
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$61,111
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$7,732,417
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$7,671,306
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$31,264
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,958,510
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,065,602
Income. Interest from US Government securities	2012-12-31	$66,781
Income. Interest from corporate debt instruments	2012-12-31	$4,329
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$254,367
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$254,367
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$14
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$7,244,048
Asset value of US Government securities at end of year	2012-12-31	$4,470,010
Asset value of US Government securities at beginning of year	2012-12-31	$4,763,551
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$59,077
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$6,525,422
Employer contributions (assets) at end of year	2012-12-31	$802,805
Employer contributions (assets) at beginning of year	2012-12-31	$663,133
Income. Dividends from common stock	2012-12-31	$193
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$28,498
Asset. Corporate debt instrument preferred debt at end of year	2012-12-31	$129,597
Asset. Corporate debt instrument preferred debt at beginning of year	2012-12-31	$56,847
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$43,278
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$7,627
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$7,644
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$297,400
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$364,700
Assets. Value of buildings and other operty used in plan operation at end of year	2012-12-31	$66,662
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-12-31	$71,369
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$2,006,750
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$2,014,786
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	BANSLEY AND KIENER, LLP
Accountancy firm EIN	2012-12-31	362152389
2011 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$-4,926
Total unrealized appreciation/depreciation of assets	2011-12-31	$-4,926
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$442,439
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$401,914
Total income from all sources (including contributions)	2011-12-31	$8,091,401
Total loss/gain on sale of assets	2011-12-31	$-8,231
Total of all expenses incurred	2011-12-31	$8,263,467
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$7,610,716
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$7,990,937
Value of total assets at end of year	2011-12-31	$8,113,745
Value of total assets at beginning of year	2011-12-31	$8,245,286
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$652,751
Total interest from all sources	2011-12-31	$90,775
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$23,927
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$23,742
Administrative expenses professional fees incurred	2011-12-31	$62,512
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$725,000
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$1,295,611
Participant contributions at end of year	2011-12-31	$81,934
Participant contributions at beginning of year	2011-12-31	$85,814
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$91,904
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$104,877
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$209,481
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$57,333
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$36,018
Other income not declared elsewhere	2011-12-31	$11,403
Administrative expenses (other) incurred	2011-12-31	$556,277
Liabilities. Value of operating payables at end of year	2011-12-31	$20,406
Liabilities. Value of operating payables at beginning of year	2011-12-31	$33,396
Total non interest bearing cash at end of year	2011-12-31	$1,143
Total non interest bearing cash at beginning of year	2011-12-31	$1,668
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-172,066
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$7,671,306
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$7,843,372
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$33,962
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$2,065,602
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$3,676,201
Income. Interest from US Government securities	2011-12-31	$87,053
Income. Interest from corporate debt instruments	2011-12-31	$3,548
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$254,367
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$352,644
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$352,644
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$174
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$7,466,520
Asset value of US Government securities at end of year	2011-12-31	$4,763,551
Asset value of US Government securities at beginning of year	2011-12-31	$3,238,391
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-12,484
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$6,695,326
Employer contributions (assets) at end of year	2011-12-31	$663,133
Employer contributions (assets) at beginning of year	2011-12-31	$560,915
Income. Dividends from common stock	2011-12-31	$185
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$52,292
Asset. Corporate debt instrument preferred debt at end of year	2011-12-31	$56,847
Asset. Corporate debt instrument preferred debt at beginning of year	2011-12-31	$52,385
Asset. Corporate debt instrument debt (other) at end of year	2011-12-31	$43,278
Assets. Corporate common stocks other than exployer securities at end of year	2011-12-31	$7,644
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$9,389
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$364,700
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$332,500
Assets. Value of buildings and other operty used in plan operation at end of year	2011-12-31	$71,369
Assets. Value of buildings and other operty used in plan operation at beginning of year	2011-12-31	$58,398
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$3,671,736
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$3,679,967
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	BANSLEY AND KIENER, LLP
Accountancy firm EIN	2011-12-31	362152389
2010 : SEIU LOCAL 73 MIDWEST BENEFITS FUND 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$3,049
Total unrealized appreciation/depreciation of assets	2010-12-31	$3,049
Total transfer of assets to this plan	2010-12-31	$2,453,735
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$401,914
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$418,518
Total income from all sources (including contributions)	2010-12-31	$8,237,306
Total loss/gain on sale of assets	2010-12-31	$-16,788
Total of all expenses incurred	2010-12-31	$8,351,224
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$7,817,193
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$8,041,778
Value of total assets at end of year	2010-12-31	$8,245,286
Value of total assets at beginning of year	2010-12-31	$5,922,073
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$534,031
Total interest from all sources	2010-12-31	$96,341
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$22,429
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$22,250
Administrative expenses professional fees incurred	2010-12-31	$100,680
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$725,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$1,354,327
Participant contributions at end of year	2010-12-31	$85,814
Participant contributions at beginning of year	2010-12-31	$16,656
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$78,531
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$209,481
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$111,927
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$36,018
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$203,845
Other income not declared elsewhere	2010-12-31	$30,043
Administrative expenses (other) incurred	2010-12-31	$398,260
Liabilities. Value of operating payables at end of year	2010-12-31	$33,396
Liabilities. Value of operating payables at beginning of year	2010-12-31	$16,873
Total non interest bearing cash at end of year	2010-12-31	$1,668
Total non interest bearing cash at beginning of year	2010-12-31	$24,922
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-113,918
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$7,843,372
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$5,503,555
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$35,091
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$3,676,201
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$0
Income. Interest from US Government securities	2010-12-31	$95,328
Income. Interest from corporate debt instruments	2010-12-31	$741
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$352,644
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$3,348,853
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$3,348,853
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$272
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$7,548,965
Asset value of US Government securities at end of year	2010-12-31	$3,238,391
Asset value of US Government securities at beginning of year	2010-12-31	$2,204,544
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$60,454
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$6,687,451
Employer contributions (assets) at end of year	2010-12-31	$560,915
Employer contributions (assets) at beginning of year	2010-12-31	$210,616
Income. Dividends from common stock	2010-12-31	$179
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$189,697
Asset. Corporate debt instrument preferred debt at end of year	2010-12-31	$52,385
Asset. Corporate debt instrument preferred debt at beginning of year	2010-12-31	$0
Contract administrator fees	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$9,389
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$332,500
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$197,800
Assets. Value of buildings and other operty used in plan operation at end of year	2010-12-31	$58,398
Assets. Value of buildings and other operty used in plan operation at beginning of year	2010-12-31	$4,555
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$1,457,570
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$1,474,358
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	BANSLEY AND KIENER, L.L.P.
Accountancy firm EIN	2010-12-31	362152389

Form 5500 Responses for SEIU LOCAL 73 MIDWEST BENEFITS FUND

2018: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2018 form 5500 responses
2018-01-01	Type of plan entity	Multi-employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2017 form 5500 responses
2017-01-01	Type of plan entity	Multi-employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2010 form 5500 responses
2010-01-01	Type of plan entity	Multi-employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: SEIU LOCAL 73 MIDWEST BENEFITS FUND 2009 form 5500 responses
2009-01-01	Type of plan entity	Multi-employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	729486
Policy instance	2
Insurance contract or identification number 729486 Number of Individuals Covered 420 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $483 Total amount of fees paid to insurance company USD $100,600 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,205,462 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $483 Amount paid for insurance broker fees 100600 Additional information about fees paid to insurance broker SERVICE FEE AGREEMENT Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00504923
Policy instance	1
Insurance contract or identification number 00504923 Number of Individuals Covered 541 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $14,371 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $363,870 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,371 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number	30010308
Policy instance	3
Insurance contract or identification number 30010308 Number of Individuals Covered 967 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $15,120 Total amount of fees paid to insurance company USD $1,754 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $152,737 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,120 Insurance broker organization code? 3 Amount paid for insurance broker fees 1754 Additional information about fees paid to insurance broker ADMINISTRATIVE FEES Insurance broker name VISION SERVICE PLAN
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00504923
Policy instance	1
Insurance contract or identification number 00504923 Number of Individuals Covered 1113 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $17,641 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $457,950 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,641 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	705830
Policy instance	2
Insurance contract or identification number 705830 Number of Individuals Covered 209 Insurance policy start date 2014-11-01 Insurance policy end date 2015-10-31 Total amount of commissions paid to insurance broker USD $2,798 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $34,836 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,798 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	729486
Policy instance	3
Insurance contract or identification number 729486 Number of Individuals Covered 1322 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,177 Total amount of fees paid to insurance company USD $233,016 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $5,280,391 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,177 Amount paid for insurance broker fees 233016 Additional information about fees paid to insurance broker SERVICE FEE AGREEMENT Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number	30010308
Policy instance	4
Insurance contract or identification number 30010308 Number of Individuals Covered 1619 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $18,923 Total amount of fees paid to insurance company USD $50,482 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $194,569 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,923 Insurance broker organization code? 3 Amount paid for insurance broker fees 50482 Additional information about fees paid to insurance broker ADMINISTRATIVE FEES Insurance broker name VISION SERVICE PLAN
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1743C
Policy instance	5
Insurance contract or identification number 1743C Number of Individuals Covered 162 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $44,446 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number	1956C1/1956C2
Policy instance	1
Insurance contract or identification number 1956C1/1956C2 Number of Individuals Covered 754 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $21,019 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $242,562 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $21,019 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
Policy contract number	Q3493
Policy instance	2
Insurance contract or identification number Q3493 Number of Individuals Covered 189 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $36,247 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,944,428 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $36,247 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	705830
Policy instance	3
Insurance contract or identification number 705830 Number of Individuals Covered 7 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $4,574 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $106,895 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,574 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number	30010308
Policy instance	4
Insurance contract or identification number 30010308 Number of Individuals Covered 1894 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $17,201 Total amount of fees paid to insurance company USD $48,277 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $179,013 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 48277 Additional information about fees paid to insurance broker ADMINISTRATIVE FEES Insurance broker organization code? 3 Commission paid to Insurance Broker USD $17,201 Insurance broker name WEINER INSURANCE, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	729486
Policy instance	7
Insurance contract or identification number 729486 Number of Individuals Covered 579 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $2,811 Total amount of fees paid to insurance company USD $172,412 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,349,076 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,811 Amount paid for insurance broker fees 172412 Additional information about fees paid to insurance broker ADMINISTRATIVE FEES Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1747C
Policy instance	6
Insurance contract or identification number 1747C Number of Individuals Covered 271 Insurance policy start date 2013-11-01 Insurance policy end date 2014-10-31 Total amount of commissions paid to insurance broker USD $1,037 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $51,925 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,037 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	00504923
Policy instance	8
Insurance contract or identification number 00504923 Number of Individuals Covered 1285 Insurance policy start date 2014-11-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $2,332 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $25,497 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,332 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1743C
Policy instance	5
Insurance contract or identification number 1743C Number of Individuals Covered 157 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $41,880 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	489124
Policy instance	15
Insurance contract or identification number 489124 Number of Individuals Covered 155 Insurance policy start date 2013-05-01 Insurance policy end date 2013-11-30 Total amount of commissions paid to insurance broker USD $20,185 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $585,917 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,185 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number	1956C1/1956C2
Policy instance	1
Insurance contract or identification number 1956C1/1956C2 Number of Individuals Covered 710 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $17,942 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $205,660 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,942 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
Policy contract number	Q3493
Policy instance	2
Insurance contract or identification number Q3493 Number of Individuals Covered 251 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $42,520 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,338,760 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $42,520 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	497824
Policy instance	18
Insurance contract or identification number 497824 Number of Individuals Covered 71 Insurance policy start date 2013-12-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $924 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $23,092 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $924 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	497824
Policy instance	17
Insurance contract or identification number 497824 Number of Individuals Covered 72 Insurance policy start date 2013-05-01 Insurance policy end date 2013-11-30 Total amount of commissions paid to insurance broker USD $6,897 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $172,299 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,897 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	489124
Policy instance	16
Insurance contract or identification number 489124 Number of Individuals Covered 155 Insurance policy start date 2013-12-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $6,657 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $84,770 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,657 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	705830
Policy instance	3
Insurance contract or identification number 705830 Number of Individuals Covered 7 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $3,385 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $85,853 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,385 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0729486
Policy instance	14
Insurance contract or identification number 0729486 Number of Individuals Covered 218 Insurance policy start date 2013-12-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $5,612 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $224,038 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 5612 Additional information about fees paid to insurance broker SERVICE FEE AGREEMENT Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0729486
Policy instance	13
Insurance contract or identification number 0729486 Number of Individuals Covered 178 Insurance policy start date 2013-05-01 Insurance policy end date 2013-11-30 Total amount of commissions paid to insurance broker USD $-135 Total amount of fees paid to insurance company USD $42,978 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,208,056 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 Amount paid for insurance broker fees 42978 Additional information about fees paid to insurance broker SERVICE FEE AGREEMENT Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0743394
Policy instance	12
Insurance contract or identification number 0743394 Number of Individuals Covered 42 Insurance policy start date 2013-12-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $1,931 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $48,248 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 1931 Additional information about fees paid to insurance broker SERVICE FEE AGREEMENT Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0743394
Policy instance	11
Insurance contract or identification number 0743394 Number of Individuals Covered 42 Insurance policy start date 2013-05-01 Insurance policy end date 2013-11-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $13,353 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $333,573 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 13353 Additional information about fees paid to insurance broker SERVICE FEE AGREEMENT Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0743394
Policy instance	10
Insurance contract or identification number 0743394 Number of Individuals Covered 41 Insurance policy start date 2012-11-01 Insurance policy end date 2013-04-30 Total amount of commissions paid to insurance broker USD $11,053 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $276,327 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,053 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0729486
Policy instance	9
Insurance contract or identification number 0729486 Number of Individuals Covered 201 Insurance policy start date 2012-05-01 Insurance policy end date 2013-04-30 Total amount of commissions paid to insurance broker USD $56,882 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,275,527 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $56,882 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	497824
Policy instance	7
Insurance contract or identification number 497824 Number of Individuals Covered 59 Insurance policy start date 2012-05-01 Insurance policy end date 2013-04-30 Total amount of commissions paid to insurance broker USD $12,892 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $257,837 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,892 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number	30010308
Policy instance	4
Insurance contract or identification number 30010308 Number of Individuals Covered 1842 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $16,483 Total amount of fees paid to insurance company USD $44,315 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $172,899 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 44315 Additional information about fees paid to insurance broker ADMINISTRATIVE FEES Insurance broker organization code? 3 Commission paid to Insurance Broker USD $16,483 Insurance broker name WEINER INSURANCE, INC.
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1747C
Policy instance	6
Insurance contract or identification number 1747C Number of Individuals Covered 299 Insurance policy start date 2012-11-01 Insurance policy end date 2013-10-31 Total amount of commissions paid to insurance broker USD $866 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $44,265 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $866 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	489124
Policy instance	8
Insurance contract or identification number 489124 Number of Individuals Covered 154 Insurance policy start date 2012-05-01 Insurance policy end date 2013-04-30 Total amount of commissions paid to insurance broker USD $50,205 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,004,095 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $50,205 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0729486
Policy instance	9
Insurance contract or identification number 0729486 Number of Individuals Covered 579 Insurance policy start date 2011-05-01 Insurance policy end date 2012-04-30 Total amount of commissions paid to insurance broker USD $68,250 Total amount of fees paid to insurance company USD $4,080 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,877,066 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $68,250 Amount paid for insurance broker fees 4080 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number	30010308
Policy instance	4
Insurance contract or identification number 30010308 Number of Individuals Covered 1945 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $16,479 Total amount of fees paid to insurance company USD $44,357 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $174,019 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 44357 Additional information about fees paid to insurance broker ADMINISTRATIVE FEES Insurance broker organization code? 3 Commission paid to Insurance Broker USD $16,479 Insurance broker name WEINER INSURANCE, INC.
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	705830
Policy instance	3
Insurance contract or identification number 705830 Number of Individuals Covered 5 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $3,516 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $57,195 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,516 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
Policy contract number	Q3493
Policy instance	2
Insurance contract or identification number Q3493 Number of Individuals Covered 290 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $50,600 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,533,766 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $50,600 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1743C
Policy instance	5
Insurance contract or identification number 1743C Number of Individuals Covered 161 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $42,577 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1747C
Policy instance	6
Insurance contract or identification number 1747C Number of Individuals Covered 324 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $951 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $48,622 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $951 Insurance broker organization code? 3 Insurance broker name WEINER INSURNACE INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	497824
Policy instance	7
Insurance contract or identification number 497824 Number of Individuals Covered 77 Insurance policy start date 2011-10-01 Insurance policy end date 2012-04-30 Total amount of commissions paid to insurance broker USD $12,226 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $244,523 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,226 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	489124
Policy instance	8
Insurance contract or identification number 489124 Number of Individuals Covered 162 Insurance policy start date 2011-07-01 Insurance policy end date 2012-04-30 Total amount of commissions paid to insurance broker USD $37,436 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $830,251 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $37,436 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0743394
Policy instance	10
Insurance contract or identification number 0743394 Number of Individuals Covered 115 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $20,513 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $512,821 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,513 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number	1956C1/1956C2
Policy instance	1
Insurance contract or identification number 1956C1/1956C2 Number of Individuals Covered 733 Insurance policy start date 2011-11-01 Insurance policy end date 2012-10-31 Total amount of commissions paid to insurance broker USD $18,194 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $209,884 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,194 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1747C
Policy instance	2
Insurance contract or identification number 1747C Number of Individuals Covered 354 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $1,179 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $55,391 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number	1956C1/1956C2
Policy instance	3
Insurance contract or identification number 1956C1/1956C2 Number of Individuals Covered 755 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $18,785 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $200,348 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	705830
Policy instance	4
Insurance contract or identification number 705830 Number of Individuals Covered 3 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $3,057 Total amount of fees paid to insurance company USD $4 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $50,559 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
Policy contract number	Q3493
Policy instance	5
Insurance contract or identification number Q3493 Number of Individuals Covered 311 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $50,802 Total amount of fees paid to insurance company USD $451 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,390,059 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	489124
Policy instance	6
Insurance contract or identification number 489124 Number of Individuals Covered 150 Insurance policy start date 2010-07-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $40,829 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $754,350 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	497824
Policy instance	7
Insurance contract or identification number 497824 Number of Individuals Covered 63 Insurance policy start date 2010-07-01 Insurance policy end date 2011-06-30 Total amount of commissions paid to insurance broker USD $23,243 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $423,974 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	0729486
Policy instance	8
Insurance contract or identification number 0729486 Number of Individuals Covered 579 Insurance policy start date 2010-05-01 Insurance policy end date 2011-04-30 Total amount of commissions paid to insurance broker USD $88,321 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,473,691 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number	30010308
Policy instance	9
Insurance contract or identification number 30010308 Number of Individuals Covered 2053 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $17,339 Total amount of fees paid to insurance company USD $46,867 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $184,026 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1743C
Policy instance	1
Insurance contract or identification number 1743C Number of Individuals Covered 163 Insurance policy start date 2010-11-01 Insurance policy end date 2011-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $47,006 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number	30010308
Policy instance	13
Insurance contract or identification number 30010308 Number of Individuals Covered 2134 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $17,674 Total amount of fees paid to insurance company USD $48,393 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $184,466 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 48393 Additional information about fees paid to insurance broker ADMINISTRATIVE FEES Insurance broker organization code? 3 Commission paid to Insurance Broker USD $17,674 Insurance broker name WEINER INSURANCE, INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	499014
Policy instance	12
Insurance contract or identification number 499014 Number of Individuals Covered 24 Insurance policy start date 2010-01-01 Insurance policy end date 2010-08-31 Total amount of commissions paid to insurance broker USD $3,552 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $93,542 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,552 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	3321068
Policy instance	1
Insurance contract or identification number 3321068 Number of Individuals Covered 361 Insurance policy start date 2009-05-01 Insurance policy end date 2010-04-30 Total amount of commissions paid to insurance broker USD $45,204 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $546,352 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,252 Insurance broker organization code? 3 Insurance broker name WEINER, MORTON
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1743C
Policy instance	2
Insurance contract or identification number 1743C Number of Individuals Covered 178 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $51,062 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 11228 )
Policy contract number	1747C
Policy instance	3
Insurance contract or identification number 1747C Number of Individuals Covered 386 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $1,145 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $58,083 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,145 Insurance broker organization code? 3 Insurance broker name WEINER INSURNACE INC.
COMPBENEFITS (National Association of Insurance Commissioners NAIC id number: 60984 )
Policy contract number	1956C1/1956C2
Policy instance	4
Insurance contract or identification number 1956C1/1956C2 Number of Individuals Covered 753 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $16,018 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $195,389 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $16,018 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number	705830
Policy instance	5
Insurance contract or identification number 705830 Number of Individuals Covered 621 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $3,105 Total amount of fees paid to insurance company USD $35 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $29,617 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,105 Amount paid for insurance broker fees 35 Additional information about fees paid to insurance broker VOLUME-BASED BONUS Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 )
Policy contract number	Q3493
Policy instance	6
Insurance contract or identification number Q3493 Number of Individuals Covered 333 Insurance policy start date 2009-11-01 Insurance policy end date 2010-10-31 Total amount of commissions paid to insurance broker USD $47,435 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,380,693 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $47,435 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	OK 960997
Policy instance	7
Insurance contract or identification number OK 960997 Number of Individuals Covered 259 Insurance policy start date 2009-10-01 Insurance policy end date 2010-04-30 Total amount of commissions paid to insurance broker USD $165 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided POOLED AD & D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,650 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $165 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	FLX960960
Policy instance	8
Insurance contract or identification number FLX960960 Number of Individuals Covered 259 Insurance policy start date 2009-10-01 Insurance policy end date 2010-04-30 Total amount of commissions paid to insurance broker USD $1,452 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $14,516 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,452 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	489124
Policy instance	10
Insurance contract or identification number 489124 Number of Individuals Covered 146 Insurance policy start date 2010-01-01 Insurance policy end date 2010-06-30 Total amount of commissions paid to insurance broker USD $19,075 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $443,727 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,075 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	497824
Policy instance	11
Insurance contract or identification number 497824 Number of Individuals Covered 114 Insurance policy start date 2010-01-01 Insurance policy end date 2010-09-30 Total amount of commissions paid to insurance broker USD $19,294 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $385,113 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,294 Insurance broker organization code? 3 Insurance broker name WEINER INSURANCE INC
OLYMPIA LTD HEALTH SERVICES INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	3500
Policy instance	9
Insurance contract or identification number 3500 Number of Individuals Covered 49 Insurance policy start date 2009-07-01 Insurance policy end date 2010-03-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,595 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No

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