401k Plan data: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS plan

ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 401k Plan overview

Plan Name	ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS
Plan identification number	501

ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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
Death benefits (include travel accident but not life insurance)
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ALLIED PHYSICIANS, INC. has sponsored the creation of one or more 401k plans.

Company Name: ALLIED PHYSICIANS, INC.

Employer identification number (EIN): 351155438

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Additional information about ALLIED PHYSICIANS, INC.

Jurisdiction of Incorporation: Nevada Department of State

Incorporation Date: 1996-07-02

Company Identification Number: 19961150202

Legal Registered Office Address: 701 S CARSON ST STE 200

CARSON CITY
United States of America (USA)
89701

More information about ALLIED PHYSICIANS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-01-01 DONALD SHOOK 2022-07-29
501 2020-01-01 DONALD R SHOOK, JR. 2021-05-24
501 2019-01-01 DONALD R SHOOK, JR 2020-09-10
501 2018-01-01
501 2017-01-01 DONALD R SHOOK DONALD R SHOOK 2018-07-25
501 2016-01-01 DONALD R SHOOK DONALD R SHOOK 2017-07-31
501 2015-01-01 AMY CROUCH AMY CROUCH
501 2015-01-01 AMY CROUCH AMY CROUCH
501 2015-01-01 AMY CROUCH AMY CROUCH 2016-07-26
501 2014-01-01 W. BARRY KUNKLE W. BARRY KUNKLE
501 2014-01-01 W. BARRY KUNKLE W. BARRY KUNKLE
501 2014-01-01 W. BARRY KUNKLE W. BARRY KUNKLE
501 2013-01-01 W. BARRY KUNKLE
501 2012-01-01 STEPHEN R. SMITH
501 2011-01-01 STEPHEN R. SMITH
501 2009-01-01 STEPHEN R. SMITH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-01-01	DONALD SHOOK	2022-07-29
501	2020-01-01	DONALD R SHOOK, JR.	2021-05-24
501	2019-01-01	DONALD R SHOOK, JR	2020-09-10
501	2018-01-01
501	2017-01-01	DONALD R SHOOK		DONALD R SHOOK	2018-07-25
501	2016-01-01	DONALD R SHOOK		DONALD R SHOOK	2017-07-31
501	2015-01-01	AMY CROUCH		AMY CROUCH
501	2015-01-01	AMY CROUCH		AMY CROUCH
501	2015-01-01	AMY CROUCH		AMY CROUCH	2016-07-26
501	2014-01-01	W. BARRY KUNKLE		W. BARRY KUNKLE
501	2014-01-01	W. BARRY KUNKLE		W. BARRY KUNKLE
501	2014-01-01	W. BARRY KUNKLE		W. BARRY KUNKLE
501	2013-01-01	W. BARRY KUNKLE
501	2012-01-01	STEPHEN R. SMITH
501	2011-01-01	STEPHEN R. SMITH
501	2009-01-01	STEPHEN R. SMITH

Plan Statistics for ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS

401k plan membership statisitcs for ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS

Measure Date Value
2021: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2021 401k membership
Total participants, beginning-of-year 2021-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 83
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 83
Number of employers contributing to the scheme 2021-01-01 0
2020: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2020 401k membership
Total participants, beginning-of-year 2020-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 97
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 97
Number of employers contributing to the scheme 2020-01-01 0
2019: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2019 401k membership
Total participants, beginning-of-year 2019-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 111
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 111
Number of employers contributing to the scheme 2019-01-01 0
2018: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2018 401k membership
Total participants, beginning-of-year 2018-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 106
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 106
Number of employers contributing to the scheme 2018-01-01 0
2017: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2017 401k membership
Total participants, beginning-of-year 2017-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 75
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 75
2016: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2016 401k membership
Total participants, beginning-of-year 2016-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 86
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 86
2015: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2015 401k membership
Total participants, beginning-of-year 2015-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 98
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 98
2014: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2014 401k membership
Total participants, beginning-of-year 2014-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 105
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 105
2013: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2013 401k membership
Total participants, beginning-of-year 2013-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 117
Total of all active and inactive participants 2013-01-01 117
2012: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2012 401k membership
Total participants, beginning-of-year 2012-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 136
Total of all active and inactive participants 2012-01-01 136
2011: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2011 401k membership
Total participants, beginning-of-year 2011-01-01 250
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 140
Total of all active and inactive participants 2011-01-01 140
2009: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2009 401k membership
Total participants, beginning-of-year 2009-01-01 408
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 390
Total of all active and inactive participants 2009-01-01 390

Measure	Date	Value
2021: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2021 401k membership
Total participants, beginning-of-year	2021-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	83
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	83
Number of employers contributing to the scheme	2021-01-01	0
2020: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2020 401k membership
Total participants, beginning-of-year	2020-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	97
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	97
Number of employers contributing to the scheme	2020-01-01	0
2019: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2019 401k membership
Total participants, beginning-of-year	2019-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	111
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	111
Number of employers contributing to the scheme	2019-01-01	0
2018: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2018 401k membership
Total participants, beginning-of-year	2018-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	106
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	106
Number of employers contributing to the scheme	2018-01-01	0
2017: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2017 401k membership
Total participants, beginning-of-year	2017-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	75
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	75
2016: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2016 401k membership
Total participants, beginning-of-year	2016-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	86
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	86
2015: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2015 401k membership
Total participants, beginning-of-year	2015-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	98
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	98
2014: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2014 401k membership
Total participants, beginning-of-year	2014-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	105
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	105
2013: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2013 401k membership
Total participants, beginning-of-year	2013-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	117
Total of all active and inactive participants	2013-01-01	117
2012: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2012 401k membership
Total participants, beginning-of-year	2012-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	136
Total of all active and inactive participants	2012-01-01	136
2011: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2011 401k membership
Total participants, beginning-of-year	2011-01-01	250
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	140
Total of all active and inactive participants	2011-01-01	140
2009: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2009 401k membership
Total participants, beginning-of-year	2009-01-01	408
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	390
Total of all active and inactive participants	2009-01-01	390

Form 5500 Responses for ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS

2021: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 benefit arrangement – Insurance	Yes
2016: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 benefit arrangement – Insurance	Yes
2015: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 benefit arrangement – Insurance	Yes
2012: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 benefit arrangement – Insurance	Yes
2011: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 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 benefit arrangement – Insurance	Yes
2009: ALLIED PHYSICIANS, INC. WELFARE BENEFIT PLANS 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

641177

Policy instance

Insurance contract or identification number	641177
Number of Individuals Covered	83
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,108
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $151,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,108
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

703

Policy instance

Insurance contract or identification number	703
Number of Individuals Covered	163
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,461
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 $3,461
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	62
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $927
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $927
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	69
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $993
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $993
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 62111 )

Policy contract number

703

Policy instance

Insurance contract or identification number	703
Number of Individuals Covered	142
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,169
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,169
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

641177

Policy instance

Insurance contract or identification number	641177
Number of Individuals Covered	97
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $10,754
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $171,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,754
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

641177

Policy instance

Insurance contract or identification number	641177
Number of Individuals Covered	111
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,873
Total amount of fees paid to insurance company	USD $505
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $175,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,924
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 62111 )

Policy contract number

703

Policy instance

Insurance contract or identification number	703
Number of Individuals Covered	142
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,925
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,925
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	71
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $942
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $814
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	68
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $921
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $921
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

703

Policy instance

Insurance contract or identification number	703
Number of Individuals Covered	167
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,705
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 $3,705
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

641177

Policy instance

Insurance contract or identification number	641177
Number of Individuals Covered	106
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,200
Total amount of fees paid to insurance company	USD $2,887
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $164,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,200
Amount paid for insurance broker fees	2887
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

703

Policy instance

Insurance contract or identification number	703
Number of Individuals Covered	144
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,637
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 $3,637
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	55
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $884
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $884
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

641177

Policy instance

Insurance contract or identification number	641177
Number of Individuals Covered	120
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,369
Total amount of fees paid to insurance company	USD $2,612
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $176,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,369
Amount paid for insurance broker fees	2612
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL32795

Policy instance

Insurance contract or identification number	HCL32795
Number of Individuals Covered	75
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $17,640
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	17640
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

645393

Policy instance

Insurance contract or identification number	645393
Number of Individuals Covered	48
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,436
Total amount of fees paid to insurance company	USD $284
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,436
Amount paid for insurance broker fees	284
Insurance broker name	HYLANT GROUP INC

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

703

Policy instance

Insurance contract or identification number	703
Number of Individuals Covered	208
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,833
Total amount of fees paid to insurance company	USD $4,823
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,833
Amount paid for insurance broker fees	4823
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	78
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $958
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $141
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )

Policy contract number

L15100805 002

Policy instance

Insurance contract or identification number	L15100805 002
Number of Individuals Covered	98
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $19,974
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	19974
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

641177

Policy instance

Insurance contract or identification number	641177
Number of Individuals Covered	124
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,283
Total amount of fees paid to insurance company	USD $5,318
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $213,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,283
Amount paid for insurance broker fees	5318
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

641177

Policy instance

Insurance contract or identification number	641177
Number of Individuals Covered	136
Insurance policy start date	2014-05-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,252
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $100,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

BK 007466

Policy instance

Insurance contract or identification number	BK 007466
Number of Individuals Covered	117
Insurance policy start date	2014-01-01
Insurance policy end date	2014-04-30
Total amount of fees paid to insurance company	USD $3,594
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	86
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $958
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL 19095

Policy instance

Insurance contract or identification number	HCL 19095
Number of Individuals Covered	105
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $21,417
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05996486

Policy instance

Insurance contract or identification number	KM05996486
Number of Individuals Covered	365
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,988
Total amount of fees paid to insurance company	USD $786
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 961153

Policy instance

Insurance contract or identification number	OK 961153
Insurance policy start date	2014-01-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $192
Total amount of fees paid to insurance company	USD $79
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $1,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX961093

Policy instance

Insurance contract or identification number	FLX961093
Insurance policy start date	2014-01-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $1,645
Total amount of fees paid to insurance company	USD $1,018
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

BK 007466

Policy instance

Insurance contract or identification number	BK 007466
Number of Individuals Covered	117
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $3,565
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $179,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3565
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

KM05996486

Policy instance

Insurance contract or identification number	KM05996486
Number of Individuals Covered	380
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,950
Total amount of fees paid to insurance company	USD $5,112
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,950
Amount paid for insurance broker fees	5112
Additional information about fees paid to insurance broker	SUPPLEMENTAL & NON-MONETARY COMP
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

FLX961093

Policy instance

Insurance contract or identification number	FLX961093
Number of Individuals Covered	117
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,509
Total amount of fees paid to insurance company	USD $1,005
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,509
Amount paid for insurance broker fees	1005
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP, INC

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL 19095

Policy instance

Insurance contract or identification number	HCL 19095
Number of Individuals Covered	117
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,808
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

OK 961153

Policy instance

Insurance contract or identification number	OK 961153
Number of Individuals Covered	117
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $590
Total amount of fees paid to insurance company	USD $81
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $590
Amount paid for insurance broker fees	81
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	89
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,013
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,013
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )

Policy contract number

30030075

Policy instance

Insurance contract or identification number	30030075
Number of Individuals Covered	83
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $905
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $905
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL 19095

Policy instance

Insurance contract or identification number	HCL 19095
Number of Individuals Covered	136
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

100-5686-00

Policy instance

Insurance contract or identification number	100-5686-00
Number of Individuals Covered	128
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,976
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,344
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,976
Insurance broker organization code?	3
Insurance broker name	HYLANT OF INDIANA, LLC

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

Policy contract number

BK 007466

Policy instance

Insurance contract or identification number	BK 007466
Number of Individuals Covered	140
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $3,504
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $178,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3504
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

OK 961153

Policy instance

Insurance contract or identification number	OK 961153
Number of Individuals Covered	140
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $605
Total amount of fees paid to insurance company	USD $85
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $605
Amount paid for insurance broker fees	85
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

FLX961093

Policy instance

Insurance contract or identification number	FLX961093
Number of Individuals Covered	140
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,502
Total amount of fees paid to insurance company	USD $1,073
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,502
Amount paid for insurance broker fees	1073
Additional information about fees paid to insurance broker	SALES & SERVICE, OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP, INC

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

Policy contract number

BK 007466

Policy instance

Insurance contract or identification number	BK 007466
Number of Individuals Covered	140
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $175,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

100-5686-00

Policy instance

Insurance contract or identification number	100-5686-00
Number of Individuals Covered	140
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,798
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $104,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX961093

Policy instance

Insurance contract or identification number	FLX961093
Number of Individuals Covered	140
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,536
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PERICO LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85561 )

Policy contract number

PX01094

Policy instance

Insurance contract or identification number	PX01094
Number of Individuals Covered	131
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $94,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 961153

Policy instance

Insurance contract or identification number	OK 961153
Number of Individuals Covered	140
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $638
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $4,255
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

00001D008535 00

Policy instance

Insurance contract or identification number	00001D008535 00
Number of Individuals Covered	168
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $903
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	903
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

BK 007466

Policy instance

Insurance contract or identification number	BK 007466
Number of Individuals Covered	254
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $242,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

OK 961153

Policy instance

Insurance contract or identification number	OK 961153
Number of Individuals Covered	250
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $809
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $5,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $809
Additional information about fees paid to insurance broker	SALES SERVICE OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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

Policy contract number

FLX961093

Policy instance

Insurance contract or identification number	FLX961093
Number of Individuals Covered	250
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,700
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,700
Additional information about fees paid to insurance broker	SALES SERVICE OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP, INC

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Company Name:	ALLIED PHYSICIANS, INC.
Employer identification number (EIN):	351155438
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Nevada Department of State
Incorporation Date:	1996-07-02
Company Identification Number:	19961150202
Legal Registered Office Address:	701 S CARSON ST STE 200 CARSON CITY United States of America (USA) 89701