LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN
Plan identification number	503

LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

LIFE CARE CENTERS OF AMERICA, INC. has sponsored the creation of one or more 401k plans.

Company Name:	LIFE CARE CENTERS OF AMERICA, INC.
Employer identification number (EIN):	620963862
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Additional information about LIFE CARE CENTERS OF AMERICA, INC.

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1985-05-01
Company Identification Number:	0007371306
Legal Registered Office Address:	3001 KEITH ST NW CLEVELAND United States of America (USA) 37312

More information about LIFE CARE CENTERS OF AMERICA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2022-01-01	TERRY HENRY,SENIOR VP OF ACCOUNTING	2023-07-13	TERRY HENRY,SENIOR VP OF ACCOUNTING	2023-07-13
503	2021-01-01	TERRY HENRY,SENIOR VP OF ACCOUNTING	2022-08-05	TERRY HENRY,SENIOR VP OF ACCOUNTING	2022-08-05
503	2020-01-01	TERRY HENRY,SENIOR VP OF ACCOUNTING	2021-07-30	TERRY HENRY,SENIOR VP OF ACCOUNTING	2021-07-30
503	2019-01-01	TERRY HENRY,SENIOR VP OF ACCOUNTING	2020-07-29	TERRY HENRY,SENIOR VP OF ACCOUNTING	2020-07-29
503	2018-01-01
503	2017-01-01
503	2016-01-01
503	2015-01-01
503	2014-01-01
503	2013-01-01
503	2012-01-01	TERRY HENRY,SENIOR VP OF ACCOUNTING
503	2011-01-01	TERRY HENRY,SENIOR VP OF ACCOUNTING
503	2010-01-01	TERRY HENRY
503	2009-10-01	TERRY HENRY

Plan Statistics for LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN

401k plan membership statisitcs for LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN

Measure	Date	Value
2022: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	21,972
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	18,838
Number of retired or separated participants receiving benefits	2022-01-01	96
Number of other retired or separated participants entitled to future benefits	2022-01-01	789
Total of all active and inactive participants	2022-01-01	19,723
Total participants	2022-01-01	19,723
2021: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	28,558
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	20,975
Number of retired or separated participants receiving benefits	2021-01-01	152
Number of other retired or separated participants entitled to future benefits	2021-01-01	845
Total of all active and inactive participants	2021-01-01	21,972
Total participants	2021-01-01	21,972
2020: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	28,377
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	27,490
Number of retired or separated participants receiving benefits	2020-01-01	166
Number of other retired or separated participants entitled to future benefits	2020-01-01	902
Total of all active and inactive participants	2020-01-01	28,558
Total participants	2020-01-01	28,558
2019: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	28,632
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	27,490
Number of retired or separated participants receiving benefits	2019-01-01	124
Number of other retired or separated participants entitled to future benefits	2019-01-01	763
Total of all active and inactive participants	2019-01-01	28,377
2018: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	28,368
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	27,745
Number of retired or separated participants receiving benefits	2018-01-01	140
Number of other retired or separated participants entitled to future benefits	2018-01-01	747
Total of all active and inactive participants	2018-01-01	28,632
2017: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	27,490
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	28,368
Number of retired or separated participants receiving benefits	2017-01-01	174
Number of other retired or separated participants entitled to future benefits	2017-01-01	1,205
Total of all active and inactive participants	2017-01-01	29,747
2016: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	27,666
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	27,490
Number of retired or separated participants receiving benefits	2016-01-01	290
Number of other retired or separated participants entitled to future benefits	2016-01-01	867
Total of all active and inactive participants	2016-01-01	28,647
2015: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	28,297
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	26,682
Number of retired or separated participants receiving benefits	2015-01-01	180
Number of other retired or separated participants entitled to future benefits	2015-01-01	804
Total of all active and inactive participants	2015-01-01	27,666
2014: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	28,844
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	26,847
Number of retired or separated participants receiving benefits	2014-01-01	175
Number of other retired or separated participants entitled to future benefits	2014-01-01	1,275
Total of all active and inactive participants	2014-01-01	28,297
2013: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	26,061
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	27,588
Number of retired or separated participants receiving benefits	2013-01-01	235
Number of other retired or separated participants entitled to future benefits	2013-01-01	1,021
Total of all active and inactive participants	2013-01-01	28,844
2012: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	23,415
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	24,890
Number of retired or separated participants receiving benefits	2012-01-01	198
Number of other retired or separated participants entitled to future benefits	2012-01-01	973
Total of all active and inactive participants	2012-01-01	26,061
2011: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	24,415
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	22,451
Number of retired or separated participants receiving benefits	2011-01-01	119
Number of other retired or separated participants entitled to future benefits	2011-01-01	845
Total of all active and inactive participants	2011-01-01	23,415
2010: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	24,573
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	23,328
Number of retired or separated participants receiving benefits	2010-01-01	311
Number of other retired or separated participants entitled to future benefits	2010-01-01	776
Total of all active and inactive participants	2010-01-01	24,415
2009: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	24,933
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	23,097
Number of retired or separated participants receiving benefits	2009-10-01	321
Number of other retired or separated participants entitled to future benefits	2009-10-01	1,155
Total of all active and inactive participants	2009-10-01	24,573

Financial Data on LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN

Measure	Date	Value
2022 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$12,135,485
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$12,739,558
Total income from all sources (including contributions)	2022-12-31	$153,107,118
Total of all expenses incurred	2022-12-31	$155,623,691
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$149,735,478
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$152,644,639
Value of total assets at end of year	2022-12-31	$23,670,805
Value of total assets at beginning of year	2022-12-31	$26,791,451
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$5,888,213
Total interest from all sources	2022-12-31	$62,479
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$59,885,741
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$5,795,756
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$1,020,013
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$179,485
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$383,558
Other income not declared elsewhere	2022-12-31	$400,000
Administrative expenses (other) incurred	2022-12-31	$2,122,427
Total non interest bearing cash at end of year	2022-12-31	$1,028,762
Total non interest bearing cash at beginning of year	2022-12-31	$916,163
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,516,573
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$11,535,320
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$14,051,893
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$3,765,786
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$16,846,287
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$24,855,275
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$24,855,275
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$62,479
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$31,605,482
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$92,758,898
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$118,129,996
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	No
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$11,956,000
Liabilities. Value of benefit claims payable at beginning of year	2022-12-31	$12,356,000
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	ELLIOTT DAVIS, LLC/PLLC
Accountancy firm EIN	2022-12-31	570381582
2021 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$12,739,558
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$14,230,970
Total income from all sources (including contributions)	2021-12-31	$156,741,082
Total of all expenses incurred	2021-12-31	$168,517,039
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$161,278,427
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$156,678,940
Value of total assets at end of year	2021-12-31	$26,791,451
Value of total assets at beginning of year	2021-12-31	$40,058,820
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$7,238,612
Total interest from all sources	2021-12-31	$62,142
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$61,319,501
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$1,020,013
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$1,685,566
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$383,558
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$2,927,970
Administrative expenses (other) incurred	2021-12-31	$3,175,351
Total non interest bearing cash at end of year	2021-12-31	$916,163
Total non interest bearing cash at beginning of year	2021-12-31	$831,253
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-11,775,957
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$14,051,893
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$25,827,850
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$4,063,261
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$24,855,275
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$37,542,001
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$37,542,001
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$62,142
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$36,049,463
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$95,359,439
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$125,228,964
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
Liabilities. Value of benefit claims payable at end of year	2021-12-31	$12,356,000
Liabilities. Value of benefit claims payable at beginning of year	2021-12-31	$11,303,000
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	ELLIOTT DAVIS, LLC/PLLC
Accountancy firm EIN	2021-12-31	570381582
2020 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$14,230,970
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$12,476,028
Total income from all sources (including contributions)	2020-12-31	$169,888,167
Total of all expenses incurred	2020-12-31	$176,955,235
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$169,931,196
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$169,627,091
Value of total assets at end of year	2020-12-31	$40,058,820
Value of total assets at beginning of year	2020-12-31	$45,370,946
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$7,024,039
Total interest from all sources	2020-12-31	$261,076
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$66,906,002
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$1,685,566
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$7,420,397
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$2,927,970
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$1,264,028
Administrative expenses (other) incurred	2020-12-31	$2,441,048
Total non interest bearing cash at end of year	2020-12-31	$831,253
Total non interest bearing cash at beginning of year	2020-12-31	$649,764
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-7,067,068
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$25,827,850
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$32,894,918
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$4,582,991
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$37,542,001
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$37,300,785
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$37,300,785
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$261,076
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$36,175,806
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$102,721,089
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$133,755,390
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	No
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$11,303,000
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$11,212,000
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	ELLIOTT DAVIS, LLC/PLLC
Accountancy firm EIN	2020-12-31	570381582
2019 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$12,476,028
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$14,895,044
Total income from all sources (including contributions)	2019-12-31	$178,238,212
Total of all expenses incurred	2019-12-31	$167,338,502
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$160,087,212
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$176,732,568
Value of total assets at end of year	2019-12-31	$45,370,946
Value of total assets at beginning of year	2019-12-31	$36,890,252
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$7,251,290
Total interest from all sources	2019-12-31	$477,644
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$70,049,980
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$7,420,397
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$2,526,517
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$1,264,028
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$2,655,044
Other income not declared elsewhere	2019-12-31	$1,028,000
Administrative expenses (other) incurred	2019-12-31	$2,315,716
Total non interest bearing cash at end of year	2019-12-31	$649,764
Total non interest bearing cash at beginning of year	2019-12-31	$443,288
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$10,899,710
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$32,894,918
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$21,995,208
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$4,935,574
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$37,300,785
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$33,920,447
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$33,920,447
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$477,644
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$39,299,171
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$106,682,588
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$120,788,041
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$11,212,000
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$12,240,000
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	ELLIOTT DAVIS, LLC/PLLC
Accountancy firm EIN	2019-12-31	570381582
2018 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$14,895,044
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$12,144,619
Total income from all sources (including contributions)	2018-12-31	$176,773,676
Total of all expenses incurred	2018-12-31	$181,367,573
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$173,840,182
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$176,509,112
Value of total assets at end of year	2018-12-31	$36,890,252
Value of total assets at beginning of year	2018-12-31	$38,733,724
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$7,527,391
Total interest from all sources	2018-12-31	$264,564
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$70,275,253
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$2,526,517
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$790,987
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$2,655,044
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$186,619
Administrative expenses (other) incurred	2018-12-31	$2,396,571
Total non interest bearing cash at end of year	2018-12-31	$443,288
Total non interest bearing cash at beginning of year	2018-12-31	$343,480
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-4,593,897
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$21,995,208
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$26,589,105
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$5,130,820
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$33,920,447
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$37,599,257
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$37,599,257
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$264,564
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$39,685,466
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$106,233,859
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$134,154,716
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$12,240,000
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$11,958,000
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	ELLIOTT DAVIS, LLC/PLLC
Accountancy firm EIN	2018-12-31	570381582
2017 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$12,144,619
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$12,260,304
Total income from all sources (including contributions)	2017-12-31	$180,733,892
Total of all expenses incurred	2017-12-31	$179,062,828
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$171,406,845
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$180,619,527
Value of total assets at end of year	2017-12-31	$38,733,724
Value of total assets at beginning of year	2017-12-31	$37,178,345
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$7,655,983
Total interest from all sources	2017-12-31	$114,365
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$70,138,152
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$790,987
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$4,878,006
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$186,619
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$978,304
Administrative expenses (other) incurred	2017-12-31	$2,466,534
Total non interest bearing cash at end of year	2017-12-31	$343,480
Total non interest bearing cash at beginning of year	2017-12-31	$225,000
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	$1,671,064
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$26,589,105
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$24,918,041
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	$5,189,449
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$37,599,257
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$32,075,339
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$32,075,339
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$114,365
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$39,825,499
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
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	$110,481,375
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$131,581,346
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$11,958,000
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$11,282,000
Did the plan have assets held for investment	2017-12-31	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	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
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	ELLIOTT DAVIS, LLC/PLLC
Accountancy firm EIN	2017-12-31	570381582
2016 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$12,260,304
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$12,906,381
Total income from all sources (including contributions)	2016-12-31	$174,292,662
Total of all expenses incurred	2016-12-31	$180,222,437
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$172,587,127
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$173,761,875
Value of total assets at end of year	2016-12-31	$37,178,345
Value of total assets at beginning of year	2016-12-31	$43,754,197
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$7,635,310
Total interest from all sources	2016-12-31	$123,317
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$66,081,671
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$4,878,006
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$1,968,405
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$978,304
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$1,216,911
Other income not declared elsewhere	2016-12-31	$407,470
Administrative expenses (other) incurred	2016-12-31	$2,382,874
Total non interest bearing cash at end of year	2016-12-31	$225,000
Total non interest bearing cash at beginning of year	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-5,929,775
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$24,918,041
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$30,847,816
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	$5,252,436
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$32,075,339
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$41,785,792
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$41,785,792
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$123,317
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$41,232,108
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
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	$107,680,204
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$131,355,019
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$11,282,000
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$11,689,470
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
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	ELLIOTT DAVIS DECOSIMO, LLC/PLLC
Accountancy firm EIN	2016-12-31	570381582
2015 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$12,906,381
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$13,026,871
Total income from all sources (including contributions)	2015-12-31	$172,055,799
Total of all expenses incurred	2015-12-31	$179,028,665
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$171,503,262
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$172,649,966
Value of total assets at end of year	2015-12-31	$43,754,197
Value of total assets at beginning of year	2015-12-31	$50,847,553
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$7,525,403
Total interest from all sources	2015-12-31	$116,982
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$63,070,928
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$1,968,405
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$1,233,103
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$1,216,911
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$2,048,550
Other income not declared elsewhere	2015-12-31	$-711,149
Administrative expenses (other) incurred	2015-12-31	$2,068,876
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$38,430,178
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	$-6,972,866
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$30,847,816
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$37,820,682
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	$5,456,527
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$41,785,792
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$11,184,272
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$11,184,272
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$116,982
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$42,425,547
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
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	$109,579,038
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$129,077,715
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$11,689,470
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$10,978,321
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
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	ELLIOTT DAVIS DECOSIMO, LLC/PLLC
Accountancy firm EIN	2015-12-31	570381582
2014 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$13,026,871
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$14,672,695
Total income from all sources (including contributions)	2014-12-31	$177,982,678
Total of all expenses incurred	2014-12-31	$173,088,775
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$164,937,100
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$175,492,580
Value of total assets at end of year	2014-12-31	$50,847,553
Value of total assets at beginning of year	2014-12-31	$47,599,474
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$8,151,675
Total interest from all sources	2014-12-31	$130,137
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$1,233,103
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$5,675,398
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$2,048,550
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$1,334,413
Other income not declared elsewhere	2014-12-31	$2,359,961
Administrative expenses (other) incurred	2014-12-31	$2,470,135
Total non interest bearing cash at end of year	2014-12-31	$38,430,178
Total non interest bearing cash at beginning of year	2014-12-31	$848,769
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	$4,893,903
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$37,820,682
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$32,926,779
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	$5,681,540
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$11,184,272
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$37,887,059
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$37,887,059
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$130,137
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$39,697,115
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	$175,492,580
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$3,188,248
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$125,239,985
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$10,978,321
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$13,338,282
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
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	ELLIOTT DAVIS DECOSIMO, LLC /PLLC
Accountancy firm EIN	2014-12-31	570381582
2013 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$14,672,695
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$13,687,131
Total income from all sources (including contributions)	2013-12-31	$168,871,944
Total of all expenses incurred	2013-12-31	$167,419,231
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$160,971,629
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$168,607,991
Value of total assets at end of year	2013-12-31	$47,599,474
Value of total assets at beginning of year	2013-12-31	$45,161,197
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$6,447,602
Total interest from all sources	2013-12-31	$98,235
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$5,675,398
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$2,731,850
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$1,334,413
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$193,131
Other income not declared elsewhere	2013-12-31	$165,718
Administrative expenses (other) incurred	2013-12-31	$831,009
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	$1,452,713
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$32,926,779
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$31,474,066
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	$5,616,593
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$38,735,828
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$41,658,933
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$41,658,933
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$98,235
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$42,551,178
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
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	$168,607,991
Employer contributions (assets) at end of year	2013-12-31	$3,188,248
Employer contributions (assets) at beginning of year	2013-12-31	$770,414
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$118,420,451
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$13,338,282
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$13,494,000
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
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	JOSEPH DECOSIMO AND COMPANY, PLLC
Accountancy firm EIN	2013-12-31	620852719
2012 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$13,687,131
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$12,988,826
Total income from all sources (including contributions)	2012-12-31	$171,054,081
Total of all expenses incurred	2012-12-31	$165,173,456
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$158,787,264
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$170,932,004
Value of total assets at end of year	2012-12-31	$45,161,197
Value of total assets at beginning of year	2012-12-31	$38,582,267
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$6,386,192
Total interest from all sources	2012-12-31	$122,077
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$563,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$2,731,850
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$369,579
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$193,131
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$57,826
Administrative expenses (other) incurred	2012-12-31	$835,392
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	$5,880,625
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$31,474,066
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$25,593,441
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	$5,550,800
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$41,658,933
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$37,664,070
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$37,664,070
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$122,077
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$41,663,007
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
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	$170,932,004
Employer contributions (assets) at end of year	2012-12-31	$770,414
Employer contributions (assets) at beginning of year	2012-12-31	$548,618
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$116,561,257
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$13,494,000
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$12,931,000
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
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	JOSEPH DECOSIMO AND COMPANY, PLLC
Accountancy firm EIN	2012-12-31	620852719
2011 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$12,988,826
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$12,950,888
Total income from all sources (including contributions)	2011-12-31	$172,243,727
Total of all expenses incurred	2011-12-31	$158,950,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$152,386,941
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$172,013,640
Value of total assets at end of year	2011-12-31	$38,582,267
Value of total assets at beginning of year	2011-12-31	$25,427,828
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$6,563,285
Total interest from all sources	2011-12-31	$204,337
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$15,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$369,579
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$941,860
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$57,826
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$196,888
Other income not declared elsewhere	2011-12-31	$25,750
Administrative expenses (other) incurred	2011-12-31	$982,389
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	$13,293,501
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$25,593,441
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$12,476,940
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	$5,580,896
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$37,664,070
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$24,300,855
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$24,300,855
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$204,337
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$41,011,594
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
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	$172,013,640
Employer contributions (assets) at end of year	2011-12-31	$548,618
Employer contributions (assets) at beginning of year	2011-12-31	$185,113
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$111,375,347
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$12,931,000
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$12,754,000
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
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	JOSEPH DECOSIMO AND COMPANY, PLLC
Accountancy firm EIN	2011-12-31	620852719
2010 : LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$12,950,888
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$14,798,999
Total income from all sources (including contributions)	2010-12-31	$147,733,226
Total of all expenses incurred	2010-12-31	$147,475,786
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$141,281,091
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$147,590,906
Value of total assets at end of year	2010-12-31	$25,427,828
Value of total assets at beginning of year	2010-12-31	$25,128,126
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$6,194,695
Total interest from all sources	2010-12-31	$142,320
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$941,860
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$1,232,880
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$196,888
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$154,626
Administrative expenses (other) incurred	2010-12-31	$590,360
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	$257,440
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$12,476,940
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$10,329,127
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	$5,604,335
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$24,300,855
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$23,707,155
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$23,707,155
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$142,320
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$35,137,234
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$147,590,906
Employer contributions (assets) at end of year	2010-12-31	$185,113
Employer contributions (assets) at beginning of year	2010-12-31	$188,091
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$106,143,857
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$12,754,000
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$14,644,373
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
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	JOSEPH DECOSIMO AND COMPANY, PLLC
Accountancy firm EIN	2010-12-31	620852719

Form 5500 Responses for LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN

2022: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
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: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: LIFE CARE CENTERS OF AMERICA, INC. WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 505 Insurance policy end date 2022-08-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,158,789 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	6807
Policy instance	12
Insurance contract or identification number 6807 Number of Individuals Covered 18838 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $49,086 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $49,086 Insurance broker organization code? 3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 18552 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $67,297 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,403,385 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $67,297 Insurance broker organization code? 3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 47 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $15,436 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $479,330 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,436 Insurance broker organization code? 3
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 205 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $41,017 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,459,423 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $41,017 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71737
Policy instance	4
Insurance contract or identification number 71737 Number of Individuals Covered 299 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $15,323 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,242,070 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,323 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71738
Policy instance	5
Insurance contract or identification number 71738 Number of Individuals Covered 34 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $2,766 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $415,259 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,766 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402743G
Policy instance	11
Insurance contract or identification number 402743G Number of Individuals Covered 11121 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $182,087 Total amount of fees paid to insurance company USD $87,868 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,284,820 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $182,087 Insurance broker organization code? 3 Amount paid for insurance broker fees 87868 Additional information about fees paid to insurance broker BONUS PAID
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001, 002
Policy instance	7
Insurance contract or identification number X13-001, 002 Number of Individuals Covered 16521 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $29,238 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,169,503 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,238 Insurance broker organization code? 3
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	8
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 10034 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $62,053 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $1,551,333 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $38,783 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	9
Insurance contract or identification number 93694 Number of Individuals Covered 164 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $9,219 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,378,856 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,219 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	10
Insurance contract or identification number 36894 Number of Individuals Covered 871 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $48,068 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,247,727 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $48,068 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71737
Policy instance	4
Insurance contract or identification number 71737 Number of Individuals Covered 228 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $15,916 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,535,517 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,916 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71738
Policy instance	5
Insurance contract or identification number 71738 Number of Individuals Covered 40 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $3,338 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $343,642 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $3,338 Insurance broker organization code? 3
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 251 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $50,373 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,563,368 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $50,373 Insurance broker organization code? 3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 19332 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $65,507 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,495,891 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $65,507 Insurance broker organization code? 3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 46 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $18,019 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $511,059 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,019 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 611 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,656,977 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001, 002
Policy instance	7
Insurance contract or identification number X13-001, 002 Number of Individuals Covered 18633 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $32,947 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,317,880 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $32,947 Insurance broker organization code? 3
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	8
Insurance contract or identification number GER-P07-177R Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $73,432 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $1,835,819 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $45,895 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	9
Insurance contract or identification number 93694 Number of Individuals Covered 212 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $15,627 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,561,714 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,627 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	10
Insurance contract or identification number 36894 Number of Individuals Covered 999 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $76,879 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,788,671 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $76,879 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402743G
Policy instance	11
Insurance contract or identification number 402743G Number of Individuals Covered 11490 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $199,743 Total amount of fees paid to insurance company USD $101,033 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,029,434 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $199,743 Insurance broker organization code? 3 Amount paid for insurance broker fees 101033 Additional information about fees paid to insurance broker BONUS PAID
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	6807
Policy instance	12
Insurance contract or identification number 6807 Number of Individuals Covered 20975 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $55,219 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,219 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71738
Policy instance	5
Insurance contract or identification number 71738 Number of Individuals Covered 44 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $2,435 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $236,602 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,435 Insurance broker organization code? 3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 54 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $18,405 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $493,067 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $18,405 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71737
Policy instance	4
Insurance contract or identification number 71737 Number of Individuals Covered 195 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $11,634 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,144,759 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,634 Insurance broker organization code? 3
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 277 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $45,253 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,522,752 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $45,253 Insurance broker organization code? 3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 27490 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $72,864 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,845,411 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $72,864 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 759 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,144,259 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001, 002
Policy instance	7
Insurance contract or identification number X13-001, 002 Number of Individuals Covered 21139 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $36,740 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,469,612 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $36,740 Insurance broker organization code? 3
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	8
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 12221 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $83,218 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,080,448 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $52,011 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402743G
Policy instance	11
Insurance contract or identification number 402743G Number of Individuals Covered 13503 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $188,647 Total amount of fees paid to insurance company USD $124,712 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,735,522 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $188,647 Insurance broker organization code? 3 Amount paid for insurance broker fees 124712 Additional information about fees paid to insurance broker BONUS PAID
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	6807
Policy instance	12
Insurance contract or identification number 6807 Number of Individuals Covered 24129 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $58,779 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $58,779 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	10
Insurance contract or identification number 36894 Number of Individuals Covered 1155 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $71,702 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,870,155 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $71,702 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	9
Insurance contract or identification number 93694 Number of Individuals Covered 242 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $14,527 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,598,774 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,527 Insurance broker organization code? 3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 27490 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $75,423 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,978,548 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $75,423 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71737
Policy instance	4
Insurance contract or identification number 71737 Number of Individuals Covered 167 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $10,182 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,052,335 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,689 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71738
Policy instance	5
Insurance contract or identification number 71738 Number of Individuals Covered 43 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,973 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $204,300 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,684 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 850 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,300,170 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001, 002
Policy instance	7
Insurance contract or identification number X13-001, 002 Number of Individuals Covered 22700 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $39,383 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,575,333 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,383 Insurance broker organization code? 3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 59 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $14,355 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $467,474 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,355 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	9
Insurance contract or identification number 93694 Number of Individuals Covered 263 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $13,906 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,548,604 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,867 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	10
Insurance contract or identification number 36894 Number of Individuals Covered 1292 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $74,100 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,251,079 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $63,234 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402743G
Policy instance	11
Insurance contract or identification number 402743G Number of Individuals Covered 14931 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $204,447 Total amount of fees paid to insurance company USD $-141,124 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,336,022 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $204,447 Insurance broker organization code? 3 Amount paid for insurance broker fees 137750
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	6807
Policy instance	12
Insurance contract or identification number 6807 Number of Individuals Covered 25900 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $66,197 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,619,666 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $66,197 Insurance broker organization code? 3
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	8
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 13316 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $90,589 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,264,733 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $90,589 Insurance broker organization code? 3
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 274 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $48,246 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,638,301 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $48,246 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71738
Policy instance	5
Insurance contract or identification number 71738 Number of Individuals Covered 40 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $2,101 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $232,906 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,101 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 851 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,273,124 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001, 002
Policy instance	7
Insurance contract or identification number X13-001, 002 Number of Individuals Covered 23924 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $39,955 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,598,211 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $39,955 Insurance broker organization code? 3
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	8
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 13979 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $88,899 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,222,487 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $55,562 Insurance broker organization code? 3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number	71737
Policy instance	4
Insurance contract or identification number 71737 Number of Individuals Covered 177 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $8,934 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $990,508 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,934 Insurance broker organization code? 3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 27490 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $74,763 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,978,457 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $74,763 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	9
Insurance contract or identification number 93694 Number of Individuals Covered 254 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $13,337 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,478,665 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,337 Insurance broker organization code? 3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	10
Insurance contract or identification number 36894 Number of Individuals Covered 1325 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $72,644 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,054,004 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $72,644 Insurance broker organization code? 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	7308
Policy instance	11
Insurance contract or identification number 7308 Number of Individuals Covered 65 Insurance policy start date 2017-10-01 Insurance policy end date 2018-09-01 Total amount of commissions paid to insurance broker USD $7,740 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $386,171 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,740 Insurance broker organization code? 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402743G
Policy instance	12
Insurance contract or identification number 402743G Number of Individuals Covered 15518 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $345,934 Total amount of fees paid to insurance company USD $278,874 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,102,950 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 278874 Insurance broker organization code? 3 Commission paid to Insurance Broker USD $208,006
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 277 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $46,278 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,534,581 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $46,278 Insurance broker organization code? 3
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	6807
Policy instance	13
Insurance contract or identification number 6807 Number of Individuals Covered 27745 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $64,511 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,451,122 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $64,511 Insurance broker organization code? 3
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 60 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $12,882 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $447,970 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,882 Insurance broker organization code? 3
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	6807
Policy instance	13
Insurance contract or identification number 6807 Number of Individuals Covered 28368 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $67,325 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,732,518 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $67,325 Insurance broker organization code? 3 Insurance broker name VAN METER INSURANCE GROUP
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 27490 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $76,072 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $4,076,715 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $76,072 Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 86 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $12,471 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $416,988 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,471 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 347 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $53,139 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,726,859 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $53,139 Insurance broker organization code? 3 Insurance broker name BRUNO MARK FINANCIAL
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	16735
Policy instance	4
Insurance contract or identification number 16735 Number of Individuals Covered 137 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $7,840 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $639,052 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,840 Insurance broker organization code? 3 Insurance broker name AON BENEFITS SERVICES, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	16737
Policy instance	5
Insurance contract or identification number 16737 Number of Individuals Covered 36 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $2,582 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $211,005 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,582 Insurance broker organization code? 3 Insurance broker name AON BENEFITS SERVICES, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 794 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,106,001 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	8
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 14785 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $98,930 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,473,255 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $61,831 Insurance broker organization code? 3 Insurance broker name HEALTH COST SOLUTIONS, INC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001, 002
Policy instance	7
Insurance contract or identification number X13-001, 002 Number of Individuals Covered 24664 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $41,311 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,652,428 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $41,311 Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	9
Insurance contract or identification number 93694 Number of Individuals Covered 254 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $17,248 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,431,774 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,248 Insurance broker organization code? 3 Insurance broker name AON BENEFITS SERVICES INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402743G
Policy instance	12
Insurance contract or identification number 402743G Number of Individuals Covered 17132 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $352,637 Total amount of fees paid to insurance company USD $0 Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,896,407 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $352,637 Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	10
Insurance contract or identification number 36894 Number of Individuals Covered 1366 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $97,299 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $8,071,350 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $97,299 Insurance broker organization code? 3 Insurance broker name AON BENEFITS SERVICES INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	7308
Policy instance	11
Insurance contract or identification number 7308 Number of Individuals Covered 61 Insurance policy start date 2016-10-01 Insurance policy end date 2017-09-01 Total amount of commissions paid to insurance broker USD $6,989 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $358,009 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,989 Insurance broker organization code? 3 Insurance broker name SERVCO INSURANCE SERVICES CORP.
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	39229
Policy instance	4
Insurance contract or identification number 39229 Number of Individuals Covered 739 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $84,819 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,765,258 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $84,819 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 807 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,176,516 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93695
Policy instance	12
Insurance contract or identification number 93695 Number of Individuals Covered 106 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $11,954 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $672,241 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $11,954 Insurance broker name AON CONSULTING, INC
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 414 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $53,263 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,717,920 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $53,263 Insurance broker name BRUNO MARK FINANCIAL
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	5
Insurance contract or identification number 36894 Number of Individuals Covered 935 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $81,144 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,559,381 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $81,144 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number	4445235
Policy instance	7
Insurance contract or identification number 4445235 Number of Individuals Covered 73 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $13,514 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $450,482 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,514 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number	1007
Policy instance	8
Insurance contract or identification number 1007 Number of Individuals Covered 17055 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $70,612 Total amount of fees paid to insurance company USD $0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,057,306 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $70,612 Insurance broker organization code? 3 Insurance broker name VMI ACQUISITION INC - PAULA BUTTS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001
Policy instance	9
Insurance contract or identification number X13-001 Number of Individuals Covered 25925 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $42,945 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,717,789 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $42,945 Insurance broker name BB&T INSURANCE SERVICES
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	10
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 15923 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $114,891 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,872,286 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $71,807 Insurance broker organization code? 3 Insurance broker name HEALTH COST SOLUTIONS
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	11
Insurance contract or identification number 93694 Number of Individuals Covered 216 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $186,780 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,050,428 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $186,780 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	402743G
Policy instance	14
Insurance contract or identification number 402743G Number of Individuals Covered 18672 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $191,365 Total amount of fees paid to insurance company USD $101,900 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,924,659 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $191,365 Amount paid for insurance broker fees 101900 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	7308
Policy instance	13
Insurance contract or identification number 7308 Number of Individuals Covered 62 Insurance policy start date 2014-10-01 Insurance policy end date 2015-09-01 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $365,722 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 62 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $14,618 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $497,620 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,618 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 26682 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $90,702 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $4,092,037 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $90,702 Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 423 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $54,481 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,836,043 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $54,481 Insurance broker name BRUNO MARK FINANCIAL
DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )
Policy contract number	000008153
Policy instance	15
Insurance contract or identification number 000008153 Number of Individuals Covered 146 Insurance policy start date 2013-03-01 Insurance policy end date 2014-02-28 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $37,490 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number	000008153
Policy instance	14
Insurance contract or identification number 000008153 Number of Individuals Covered 158 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $56,281 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93695
Policy instance	13
Insurance contract or identification number 93695 Number of Individuals Covered 130 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $13,225 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $789,571 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,225 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	12
Insurance contract or identification number 93694 Number of Individuals Covered 209 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $17,663 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $964,590 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,663 Insurance broker name AON CONSULTING, INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	010112360
Policy instance	10
Insurance contract or identification number 010112360 Number of Individuals Covered 601 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $21,904 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided LTD Welfare Benefit Premiums Paid to Carrier USD $145,246 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $21,904 Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SVCS INC
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	11
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 15922 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $150,960 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $3,773,999 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $94,350 Insurance broker organization code? 3 Insurance broker name HEALTH COST SOLUTIONS
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001
Policy instance	9
Insurance contract or identification number X13-001 Number of Individuals Covered 28007 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $49,037 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,634,577 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $49,037 Insurance broker name BB&T INSURANCE SERVICES
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number	4445235
Policy instance	7
Insurance contract or identification number 4445235 Number of Individuals Covered 88 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $15,331 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $516,555 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,331 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 787 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,099,491 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	5
Insurance contract or identification number 36894 Number of Individuals Covered 986 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $80,995 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,445,626 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $80,995 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number	1007
Policy instance	8
Insurance contract or identification number 1007 Number of Individuals Covered 16085 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,490,852 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	39229
Policy instance	4
Insurance contract or identification number 39229 Number of Individuals Covered 824 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $92,349 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,037,521 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $92,349 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 26847 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $4,075,085 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Insurance broker organization code? 3 Insurance broker name
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 65 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $15,411 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $507,174 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,411 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	75689
Policy instance	16
Insurance contract or identification number 75689 Number of Individuals Covered 209 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $927,406 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )
Policy contract number	000008153
Policy instance	16
Insurance contract or identification number 000008153 Number of Individuals Covered 131 Insurance policy start date 2012-03-01 Insurance policy end date 2013-02-28 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $39,743 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 70 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $14,486 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $472,538 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,486 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 391 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $45,964 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,564,953 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $45,964 Insurance broker name BRUNO MARK FINANCIAL
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	5
Insurance contract or identification number 36894 Number of Individuals Covered 1072 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $76,955 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $4,677,795 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $76,955 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	6
Insurance contract or identification number 101534 Number of Individuals Covered 794 Insurance policy start date 2013-01-01 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 $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,803,238 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number	4445235
Policy instance	7
Insurance contract or identification number 4445235 Number of Individuals Covered 83 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $19,539 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $576,974 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $19,539 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	39229
Policy instance	4
Insurance contract or identification number 39229 Number of Individuals Covered 893 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $85,518 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,198,244 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $85,518 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	010112360
Policy instance	10
Insurance contract or identification number 010112360 Number of Individuals Covered 613 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $17,531 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided LTD Welfare Benefit Premiums Paid to Carrier USD $116,876 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,531 Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number	000008153
Policy instance	15
Insurance contract or identification number 000008153 Number of Individuals Covered 202 Insurance policy start date 2012-10-01 Insurance policy end date 2013-09-30 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $70,373 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number	1007
Policy instance	8
Insurance contract or identification number 1007 Number of Individuals Covered 17797 Insurance policy start date 2013-01-01 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 $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,704,903 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001
Policy instance	9
Insurance contract or identification number X13-001 Number of Individuals Covered 27689 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $44,477 Total amount of fees paid to insurance company USD $66,715 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,482,558 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $44,477 Amount paid for insurance broker fees 66715 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	75689
Policy instance	12
Insurance contract or identification number 75689 Insurance policy start date 2013-01-01 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 $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Welfare Benefit Premiums Paid to Carrier USD $719,106 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	11
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 16637 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $279,317 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $3,990,257 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $159,610 Insurance broker organization code? 3 Insurance broker name HEALTH COST SOLUTIONS
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	13
Insurance contract or identification number 93694 Number of Individuals Covered 222 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $15,055 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $915,115 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $15,055 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93695
Policy instance	14
Insurance contract or identification number 93695 Number of Individuals Covered 132 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $13,558 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $824,115 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,558 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 27588 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $72,613 Total amount of fees paid to insurance company USD $254,145 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,630,647 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $72,613 Amount paid for insurance broker fees 254145 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3 Insurance broker name GROUP INSURANCE SERVICES INC
DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )
Policy contract number	000008153
Policy instance	17
Insurance contract or identification number 000008153 Number of Individuals Covered 134 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $39,237 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93695
Policy instance	16
Insurance contract or identification number 93695 Number of Individuals Covered 160 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $17,196 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,039,266 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $17,196 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 0 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,568,432 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36893
Policy instance	4
Insurance contract or identification number 36893 Number of Individuals Covered 0 Insurance policy start date 2012-01-01 Insurance policy end date 2012-06-30 Total amount of commissions paid to insurance broker USD $10,332 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,070,569 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,332 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	39229
Policy instance	5
Insurance contract or identification number 39229 Number of Individuals Covered 942 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $87,266 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,754,233 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $87,266 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	6
Insurance contract or identification number 36894 Number of Individuals Covered 989 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $65,717 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,073,292 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $65,717 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	7
Insurance contract or identification number 101534 Number of Individuals Covered 769 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,689,051 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number	4445235
Policy instance	8
Insurance contract or identification number 4445235 Number of Individuals Covered 109 Insurance policy start date 2012-10-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $20,681 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $634,070 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,681 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 )
Policy contract number	X13-001
Policy instance	10
Insurance contract or identification number X13-001 Number of Individuals Covered 26655 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $41,538 Total amount of fees paid to insurance company USD $73,174 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,384,609 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $41,538 Amount paid for insurance broker fees 73174 Additional information about fees paid to insurance broker INSURANCE FEES Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	010112360
Policy instance	11
Insurance contract or identification number 010112360 Number of Individuals Covered 573 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $20,188 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided LTD Welfare Benefit Premiums Paid to Carrier USD $134,589 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,188 Insurance broker organization code? 3 Insurance broker name BB&T INSURANCE SERVICES
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	12
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 16845 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $112,663 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,816,563 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $112,663 Insurance broker organization code? 3 Insurance broker name HEALTH COST SOLUTIONS
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	75689
Policy instance	13
Insurance contract or identification number 75689 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Welfare Benefit Premiums Paid to Carrier USD $714,573 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93693
Policy instance	14
Insurance contract or identification number 93693 Number of Individuals Covered 0 Insurance policy start date 2012-01-01 Insurance policy end date 2012-06-30 Total amount of commissions paid to insurance broker USD $2,933 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $143,091 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,933 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	15
Insurance contract or identification number 93694 Number of Individuals Covered 194 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $13,226 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $844,765 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,226 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 24890 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $70,857 Total amount of fees paid to insurance company USD $247,998 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,542,835 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $70,857 Amount paid for insurance broker fees 247998 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3 Insurance broker name GROUP INSURANCE SERVICES INC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number	1007
Policy instance	9
Insurance contract or identification number 1007 Number of Individuals Covered 17580 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,521,492 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 63 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $13,867 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $480,959 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,867 Insurance broker organization code? 3 Insurance broker name AON CONSULTING, INC
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36893
Policy instance	4
Insurance contract or identification number 36893 Number of Individuals Covered 167 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $20,106 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,167,772 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	39229
Policy instance	5
Insurance contract or identification number 39229 Number of Individuals Covered 989 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $94,917 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,506,523 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	6
Insurance contract or identification number 36894 Number of Individuals Covered 799 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $58,852 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,406,937 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	7
Insurance contract or identification number 101534 Number of Individuals Covered 672 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,448,499 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number	1007
Policy instance	9
Insurance contract or identification number 1007 Number of Individuals Covered 17391 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,519,966 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001
Policy instance	10
Insurance contract or identification number X13-001 Number of Individuals Covered 20785 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $40,652 Total amount of fees paid to insurance company USD $73,174 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,626,094 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	010112360
Policy instance	11
Insurance contract or identification number 010112360 Number of Individuals Covered 570 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $19,570 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided LTD Welfare Benefit Premiums Paid to Carrier USD $130,464 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	12
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 17004 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $194,965 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,437,054 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	75689
Policy instance	13
Insurance contract or identification number 75689 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Welfare Benefit Premiums Paid to Carrier USD $768,865 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93693
Policy instance	14
Insurance contract or identification number 93693 Number of Individuals Covered 43 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $4,905 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $281,901 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93694
Policy instance	15
Insurance contract or identification number 93694 Number of Individuals Covered 155 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $12,223 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $703,763 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	93695
Policy instance	16
Insurance contract or identification number 93695 Number of Individuals Covered 185 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $18,150 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,039,057 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 64 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $14,018 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $471,074 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 22451 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $70,284 Total amount of fees paid to insurance company USD $245,995 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,514,215 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 382 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $60,032 Total amount of fees paid to insurance company USD $1,575 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,500,837 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number	4445235
Policy instance	8
Insurance contract or identification number 4445235 Number of Individuals Covered 117 Insurance policy start date 2011-10-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $20,710 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $635,498 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )
Policy contract number	111762
Policy instance	2
Insurance contract or identification number 111762 Number of Individuals Covered 63 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $12,864 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $482,439 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number	10002352
Policy instance	3
Insurance contract or identification number 10002352 Number of Individuals Covered 403 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $60,789 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,434,992 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36893
Policy instance	4
Insurance contract or identification number 36893 Number of Individuals Covered 195 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $37,622 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,037,318 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	39229
Policy instance	5
Insurance contract or identification number 39229 Number of Individuals Covered 984 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $86,226 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,011,392 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number	101534
Policy instance	7
Insurance contract or identification number 101534 Number of Individuals Covered 671 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $3,279,876 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	36894
Policy instance	6
Insurance contract or identification number 36894 Number of Individuals Covered 743 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $39,367 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $2,394,526 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number	4445235
Policy instance	8
Insurance contract or identification number 4445235 Number of Individuals Covered 121 Insurance policy start date 2010-10-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $20,411 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $620,540 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number	1007
Policy instance	9
Insurance contract or identification number 1007 Number of Individuals Covered 17331 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,138,129 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number	X13-001
Policy instance	10
Insurance contract or identification number X13-001 Number of Individuals Covered 11560 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $30,345 Total amount of fees paid to insurance company USD $54,620 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,213,780 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	010112360
Policy instance	11
Insurance contract or identification number 010112360 Number of Individuals Covered 559 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $18,772 Total amount of fees paid to insurance company USD $3,085 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided LTD Welfare Benefit Premiums Paid to Carrier USD $125,143 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number	GER-P07-177R
Policy instance	12
Insurance contract or identification number GER-P07-177R Number of Individuals Covered 17408 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $168,469 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Other welfare benefits provided STOP-LOSS Welfare Benefit Premiums Paid to Carrier USD $2,105,864 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	FHM111169
Policy instance	1
Insurance contract or identification number FHM111169 Number of Individuals Covered 23328 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $68,057 Total amount of fees paid to insurance company USD $375,361 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $3,402,845 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )
Policy contract number	75689
Policy instance	13
Insurance contract or identification number 75689 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Welfare Benefit Premiums Paid to Carrier USD $747,256 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes

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