GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN
Plan identification number	501

GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE 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 Other welfare benefit cover

401k Sponsoring company profile

GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC has sponsored the creation of one or more 401k plans.

Company Name:	GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC
Employer identification number (EIN):	581249683
NAIC Classification:	611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-01-01
501	2019-01-01
501	2018-01-01	TRACI HALL
501	2017-01-01
501	2016-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2015-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2014-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2013-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2012-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2011-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2010-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2009-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2008-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2007-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2006-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2005-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2004-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2003-01-01	TRACI HALL		TRACI HALL	2018-02-14
501	2002-01-01	TRACI HALL		TRACI HALL	2018-02-14

Plan Statistics for GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN

Measure	Date	Value
2020: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	359
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
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	0
2019: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	302
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	290
Number of retired or separated participants receiving benefits	2019-01-01	16
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	306
2018: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	200
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	314
Total of all active and inactive participants	2018-01-01	314
Total participants	2018-01-01	314
2017: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	200
Total of all active and inactive participants	2017-01-01	200
Total participants	2017-01-01	200
2016: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	341
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	281
Total of all active and inactive participants	2016-01-01	281
Total participants	2016-01-01	281
2015: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	349
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	341
Total of all active and inactive participants	2015-01-01	341
Total participants	2015-01-01	341
2014: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	493
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	349
Total of all active and inactive participants	2014-01-01	349
Total participants	2014-01-01	349
2013: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	359
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	493
Total of all active and inactive participants	2013-01-01	493
Total participants	2013-01-01	493
2012: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	345
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	359
Total of all active and inactive participants	2012-01-01	359
Total participants	2012-01-01	359
2011: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	339
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	345
Total of all active and inactive participants	2011-01-01	345
Total participants	2011-01-01	345
2010: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	322
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	339
Total of all active and inactive participants	2010-01-01	339
Total participants	2010-01-01	339
2009: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	346
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	322
Total of all active and inactive participants	2009-01-01	322
Total participants	2009-01-01	322
2008: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	347
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	346
Total of all active and inactive participants	2008-01-01	346
Total participants	2008-01-01	346
2007: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	305
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	347
Total of all active and inactive participants	2007-01-01	347
Total participants	2007-01-01	347
2006: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	217
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	305
Total of all active and inactive participants	2006-01-01	305
Total participants	2006-01-01	305
2005: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2005 401k membership
Total participants, beginning-of-year	2005-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	217
Total of all active and inactive participants	2005-01-01	217
Total participants	2005-01-01	217
2004: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2004 401k membership
Total participants, beginning-of-year	2004-01-01	268
Total number of active participants reported on line 7a of the Form 5500	2004-01-01	207
Total of all active and inactive participants	2004-01-01	207
Total participants	2004-01-01	207
2003: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2003 401k membership
Total participants, beginning-of-year	2003-01-01	253
Total number of active participants reported on line 7a of the Form 5500	2003-01-01	268
Total of all active and inactive participants	2003-01-01	268
Total participants	2003-01-01	268
2002: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2002 401k membership
Total participants, beginning-of-year	2002-01-01	229
Total number of active participants reported on line 7a of the Form 5500	2002-01-01	253
Total of all active and inactive participants	2002-01-01	253
Total participants	2002-01-01	253

Form 5500 Responses for GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN

2020: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
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: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
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: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
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: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2006: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2005: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – Insurance	Yes
2005-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-01-01	Plan benefit arrangement – Insurance	Yes
2005-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2004: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	Submission has been amended	No
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No
2004-01-01	Plan funding arrangement – Insurance	Yes
2004-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-01-01	Plan benefit arrangement – Insurance	Yes
2004-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2003: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2003 form 5500 responses
2003-01-01	Type of plan entity	Single employer plan
2003-01-01	Submission has been amended	No
2003-01-01	This submission is the final filing	No
2003-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2003-01-01	Plan is a collectively bargained plan	No
2003-01-01	Plan funding arrangement – Insurance	Yes
2003-01-01	Plan benefit arrangement – Insurance	Yes
2002: GOODWILL INDUSTRIES OF MIDDLE GEORGIA, INC. FLEXIBLE BENEFITS PLAN 2002 form 5500 responses
2002-01-01	Type of plan entity	Single employer plan
2002-01-01	First time form 5500 has been submitted	Yes
2002-01-01	Submission has been amended	No
2002-01-01	This submission is the final filing	No
2002-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2002-01-01	Plan is a collectively bargained plan	No
2002-01-01	Plan funding arrangement – Insurance	Yes
2002-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	40000100023479
Policy instance	10
Insurance contract or identification number 40000100023479 Number of Individuals Covered 151 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $5,121 Total amount of fees paid to insurance company USD $192 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY: CHILD LIFE, SPOUSE LIFE AND AD&D, LIFE AND AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $34,138 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,281 Amount paid for insurance broker fees 192 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E7877574
Policy instance	1
Insurance contract or identification number E7877574 Number of Individuals Covered 37 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,221 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit Yes Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $18,975 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $479 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker N/A Insurance broker organization code? 3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	69120-8
Policy instance	2
Insurance contract or identification number 69120-8 Number of Individuals Covered 102 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $9,188 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENT, VOLUNTARY CRITICAL ILLNESS, VOLUNTARY HOSPITAL CONFINEMENT INDEMNITY Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $36,728 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,188 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker N/A Insurance broker organization code? 3
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	002716
Policy instance	3
Insurance contract or identification number 002716 Number of Individuals Covered 490 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EAP Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,982 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	000010237268
Policy instance	4
Insurance contract or identification number 000010237268 Number of Individuals Covered 104 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $5,867 Total amount of fees paid to insurance company USD $187 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $39,114 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,879 Amount paid for insurance broker fees 187 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	GA6771
Policy instance	5
Insurance contract or identification number GA6771 Number of Individuals Covered 422 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,016 Total amount of fees paid to insurance company USD $337 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $531,220 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,016 Amount paid for insurance broker fees 337 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	GA7798
Policy instance	6
Insurance contract or identification number GA7798 Number of Individuals Covered 63 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $707 Total amount of fees paid to insurance company USD $87 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,004 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $707 Amount paid for insurance broker fees 87 Additional information about fees paid to insurance broker FEES PAID Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0916447
Policy instance	7
Insurance contract or identification number 0916447 Number of Individuals Covered 131 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $1,895 Total amount of fees paid to insurance company USD $38,950 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $830,687 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,895 Amount paid for insurance broker fees 38950 Additional information about fees paid to insurance broker SERVICE FEE AGREEMENT Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10237266
Policy instance	8
Insurance contract or identification number 10237266 Number of Individuals Covered 300 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $2,901 Total amount of fees paid to insurance company USD $106 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $19,341 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,291 Amount paid for insurance broker fees 106 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10237267
Policy instance	9
Insurance contract or identification number 10237267 Number of Individuals Covered 152 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $6,351 Total amount of fees paid to insurance company USD $233 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $42,339 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,087 Amount paid for insurance broker fees 233 Additional information about fees paid to insurance broker BROKER BONUS Insurance broker organization code? 3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E7877574
Policy instance	1
Insurance contract or identification number E7877574 Number of Individuals Covered 40 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,166 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 1 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit Yes Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $19,829 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	69120-8
Policy instance	2
Insurance contract or identification number 69120-8 Number of Individuals Covered 154 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $18,297 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENT, VOLUNTARY CRITICAL ILLNESS, VOLUNTARY HOSPITAL CONFINEMENT INDEMNITY Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $51,000 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	002716
Policy instance	3
Insurance contract or identification number 002716 Number of Individuals Covered 490 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EAP Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,290 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	000010237268
Policy instance	4
Insurance contract or identification number 000010237268 Number of Individuals Covered 87 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $5,612 Total amount of fees paid to insurance company USD $172 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $37,413 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	GA6771
Policy instance	5
Insurance contract or identification number GA6771 Number of Individuals Covered 443 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $1,042 Total amount of fees paid to insurance company USD $163 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $636,630 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	GA7798
Policy instance	6
Insurance contract or identification number GA7798 Number of Individuals Covered 135 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $3,613 Total amount of fees paid to insurance company USD $321 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $191,732 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA7798
Policy instance	7
Insurance contract or identification number GA7798 Number of Individuals Covered 135 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $36 Total amount of fees paid to insurance company USD $3 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,335 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0916447
Policy instance	8
Insurance contract or identification number 0916447 Number of Individuals Covered 277 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $3,821 Total amount of fees paid to insurance company USD $40,159 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $863,620 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	10237266
Policy instance	9
Insurance contract or identification number 10237266 Number of Individuals Covered 329 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $3,183 Total amount of fees paid to insurance company USD $91 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $21,220 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	10237267
Policy instance	10
Insurance contract or identification number 10237267 Number of Individuals Covered 184 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $7,000 Total amount of fees paid to insurance company USD $189 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $46,667 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	40000100023479
Policy instance	11
Insurance contract or identification number 40000100023479 Number of Individuals Covered 144 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $5,766 Total amount of fees paid to insurance company USD $190 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided VOLUNTARY: CHILD LIFE, SPOUSE LIFE AND AD&D, LIFE AND AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $38,438 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number	E7877574
Policy instance	1
Insurance contract or identification number E7877574 Number of Individuals Covered 53 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,837 Are there contracts with allocated funds for individual policies? 1 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit Yes Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No 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
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	69120-8
Policy instance	2
Insurance contract or identification number 69120-8 Number of Individuals Covered 214 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $8,469 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $43,093 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,469
MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	002716
Policy instance	3
Insurance contract or identification number 002716 Number of Individuals Covered 490 Insurance policy start date 2018-01-01 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 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $9,671 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	000010237268
Policy instance	4
Insurance contract or identification number 000010237268 Number of Individuals Covered 120 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $5,172 Total amount of fees paid to insurance company USD $1,454 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $34,482 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Amount paid for insurance broker fees 1221
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number
Policy instance	1
Number of Individuals Covered 215 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $175,485 Total amount of fees paid to insurance company USD $5,162 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $26,104 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number
Policy instance	2
Number of Individuals Covered 294 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $38,505 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $38,505
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	JW729
Policy instance	2
Insurance contract or identification number JW729 Number of Individuals Covered 258 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $14,334 Total amount of fees paid to insurance company USD $4,759 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $98,877 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $14,334 Amount paid for insurance broker fees 4759 Additional information about fees paid to insurance broker SERVICE FEE AND BONUS Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	1
Insurance contract or identification number 1043740000 Number of Individuals Covered 244 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $568 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $19,593 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $568 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & COMPANY
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	1
Insurance contract or identification number 1043740000 Number of Individuals Covered 0 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $1,051 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1043740000
Policy instance	2
Insurance contract or identification number 1043740000 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 $4,681 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $5,007 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $4,681 Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	3
Insurance contract or identification number 1043740000 Number of Individuals Covered 214 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $12,571 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	4
Insurance contract or identification number GA1970 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 $681 Total amount of fees paid to insurance company USD $572 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $681 Amount paid for insurance broker fees 572 Additional information about fees paid to insurance broker SERVICE FEE AND BONUS Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	JW729
Policy instance	5
Insurance contract or identification number JW729 Number of Individuals Covered 212 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $12,915 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $88,777 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $12,915 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	6
Insurance contract or identification number 1043740000 Number of Individuals Covered 90 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $308,201 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	5
Insurance contract or identification number GA1970 Number of Individuals Covered 92 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $19,502 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	4
Insurance contract or identification number GA1970 Number of Individuals Covered 97 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $12,890 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1043740000
Policy instance	3
Insurance contract or identification number 1043740000 Number of Individuals Covered 178 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $42,564 Total amount of fees paid to insurance company USD $1,813 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $754,274 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $42,564 Amount paid for insurance broker fees 1813 Additional information about fees paid to insurance broker SERVICE FEE AND BONUS Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	2
Insurance contract or identification number 1043740000 Number of Individuals Covered 213 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,475 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	1
Insurance contract or identification number GA1970 Number of Individuals Covered 218 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $6,292 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $27,176 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $6,292 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	1
Insurance contract or identification number GA1970 Number of Individuals Covered 162 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $5,315 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $22,037 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $5,315 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	2
Insurance contract or identification number 1043740000 Number of Individuals Covered 157 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $11,803 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1043740000
Policy instance	3
Insurance contract or identification number 1043740000 Number of Individuals Covered 157 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $35,669 Total amount of fees paid to insurance company USD $5,995 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $561,888 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,634 Amount paid for insurance broker fees 5995 Additional information about fees paid to insurance broker SERVICE FEE AND BONUS Insurance broker organization code? 3 Insurance broker name ASCENSION INSURANCE, INC.
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	4
Insurance contract or identification number GA1970 Number of Individuals Covered 58 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $11,086 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	5
Insurance contract or identification number GA1970 Number of Individuals Covered 88 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,341 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	6
Insurance contract or identification number 1043740000 Number of Individuals Covered 62 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $221,383 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number	1043740000
Policy instance	5
Insurance contract or identification number 1043740000 Number of Individuals Covered 110 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	4
Insurance contract or identification number GA1970 Number of Individuals Covered 74 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	3
Insurance contract or identification number GA1970 Number of Individuals Covered 137 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	2
Insurance contract or identification number GA1970 Number of Individuals Covered 49 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1043740000
Policy instance	1
Insurance contract or identification number 1043740000 Number of Individuals Covered 155 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	2
Insurance contract or identification number GA1970 Number of Individuals Covered 48 Insurance policy start date 2008-01-01 Insurance policy end date 2008-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	3
Insurance contract or identification number GA1970 Number of Individuals Covered 74 Insurance policy start date 2008-01-01 Insurance policy end date 2008-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1043740000
Policy instance	4
Insurance contract or identification number 1043740000 Number of Individuals Covered 207 Insurance policy start date 2008-01-01 Insurance policy end date 2008-12-31 Total amount of commissions paid to insurance broker USD $43,737 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $43,737 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO
GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )
Policy contract number	GA1970
Policy instance	1
Insurance contract or identification number GA1970 Number of Individuals Covered 159 Insurance policy start date 2008-01-01 Insurance policy end date 2008-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	H42756
Policy instance	5
Insurance contract or identification number H42756 Number of Individuals Covered 6 Insurance policy start date 2007-01-01 Insurance policy end date 2007-12-31 Total amount of fees paid to insurance company USD $2,600 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $34,967 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 2600 Additional information about fees paid to insurance broker SERVICE FEE AND BONUS Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & COMPANY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	GRH-850664
Policy instance	4
Insurance contract or identification number GRH-850664 Number of Individuals Covered 33 Insurance policy start date 2007-01-01 Insurance policy end date 2007-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	0GL-850664
Policy instance	3
Insurance contract or identification number 0GL-850664 Number of Individuals Covered 159 Insurance policy start date 2007-01-01 Insurance policy end date 2007-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	H29681
Policy instance	2
Insurance contract or identification number H29681 Number of Individuals Covered 127 Insurance policy start date 2007-01-01 Insurance policy end date 2007-12-31 Total amount of fees paid to insurance company USD $32,934 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $537,161 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 32934 Additional information about fees paid to insurance broker SERVICE FEE AND BONUS Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	GLT-850664
Policy instance	1
Insurance contract or identification number GLT-850664 Number of Individuals Covered 69 Insurance policy start date 2007-01-01 Insurance policy end date 2007-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	GRH-850664
Policy instance	1
Insurance contract or identification number GRH-850664 Number of Individuals Covered 33 Insurance policy start date 2006-01-01 Insurance policy end date 2006-12-31 Total amount of commissions paid to insurance broker USD $817 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $6,287 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $817 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number	H29681
Policy instance	3
Insurance contract or identification number H29681 Number of Individuals Covered 134 Insurance policy start date 2006-01-01 Insurance policy end date 2006-12-31 Total amount of fees paid to insurance company USD $30,787 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $555,495 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 30787 Additional information about fees paid to insurance broker SERVICE FEE AND BONUS Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	0GL-850664
Policy instance	4
Insurance contract or identification number 0GL-850664 Number of Individuals Covered 128 Insurance policy start date 2006-01-01 Insurance policy end date 2006-12-31 Total amount of commissions paid to insurance broker USD $2,336 Total amount of fees paid to insurance company USD $1,203 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $16,489 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,336 Amount paid for insurance broker fees 1203 Additional information about fees paid to insurance broker ALLOCATION OF CONTINGENT COMMISSIONS CONSIDERED IN DETERMINING HARTFORD COMPENSATION PROGRAM ELIGIBILITY Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	GLT-850664
Policy instance	2
Insurance contract or identification number GLT-850664 Number of Individuals Covered 0 Insurance policy start date 2006-01-01 Insurance policy end date 2006-12-31 Total amount of commissions paid to insurance broker USD $717 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $5,515 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $717 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	GLT-850664
Policy instance	4
Insurance contract or identification number GLT-850664 Number of Individuals Covered 9 Insurance policy start date 2005-01-01 Insurance policy end date 2005-12-31 Total amount of commissions paid to insurance broker USD $363 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $2,792 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $363 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1003125000
Policy instance	3
Insurance contract or identification number 1003125000 Number of Individuals Covered 165 Insurance policy start date 2005-01-01 Insurance policy end date 2005-12-31 Total amount of commissions paid to insurance broker USD $18,851 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $18,851 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	0GL-850664
Policy instance	2
Insurance contract or identification number 0GL-850664 Number of Individuals Covered 116 Insurance policy start date 2005-01-01 Insurance policy end date 2005-12-31 Total amount of commissions paid to insurance broker USD $1,998 Total amount of fees paid to insurance company USD $1,778 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH & DISMEMBERMENT Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $13,774 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,998 Amount paid for insurance broker fees 1778 Additional information about fees paid to insurance broker ALLOCATION OF CONTINGENT COMMISSIONS CONSIDERED IN DETERMINING HARTFORD COMPENSATION PROGRAM ELIGIBILITY Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number	GRH-850664
Policy instance	1
Insurance contract or identification number GRH-850664 Number of Individuals Covered 29 Insurance policy start date 2005-01-01 Insurance policy end date 2005-12-31 Total amount of commissions paid to insurance broker USD $626 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $4,813 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $626 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO
BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1003125000
Policy instance	1
Insurance contract or identification number 1003125000 Number of Individuals Covered 203 Insurance policy start date 2004-01-01 Insurance policy end date 2004-12-31 Total amount of commissions paid to insurance broker USD $17,631 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $17,631 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1003125000
Policy instance	2
Insurance contract or identification number 1003125000 Number of Individuals Covered 203 Insurance policy start date 2003-01-01 Insurance policy end date 2003-12-31 Total amount of commissions paid to insurance broker USD $16,329 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,802 Insurance broker organization code? 3 Insurance broker name J. SMITH LANIER & CO.
BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number	1003125000
Policy instance	2
Insurance contract or identification number 1003125000 Number of Individuals Covered 152 Insurance policy start date 2002-01-01 Insurance policy end date 2002-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes

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• GOODWILL INDUSTRIES OF FORT WORTH 401(K) PLAN [EIN = 750868393]
• GOODWILL INDUSTRIES OF GREATER NY/NORTHERN NJ GROUP HEALTH PLAN [EIN = 131641068]
• GOODWILL INDUSTRIES OF CENTRAL OKLAHOMA, INC. GROUP DENTAL PLAN [EIN = 730641590]
• GOODWILL INDUSTRIES OF CENTRAL MICHIGANS HEARTLAND BENEFITS PROGRAM [EIN = 381426892]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL WISCONSIN, INC. PENSION PLAN [EIN = 391147571]
• GOODWILL INDUSTRIES OF EASTERN NORTH CAROLINA INC. HEALTH AND WELFARE PLAN [EIN = 560861003]
• GOODWILL INDUSTRIES OF DELAWARE AND DELAWARE COUNTY 403 (B) PLAN [EIN = 510064311]
• GOODWILL INDUSTRIES OF UPPER SC FLEXIBLE BENEFIT PLAN [EIN = 570564001]
• GOODWILL INDUSTRIES OF NE IOWA INC GROUP LIFE, SHORT-TERM AND LONG-TERM DISABILITY PLAN [EIN = 420839399]
• GOODWILL INDUSTRIES OF MID MICHIGAN [EIN = 381358009]
• GOODWILL INDUSTRIES OF CENTRAL OKLAHOMA, INC. 401(K) PLAN [EIN = 730641590]
• GOODWILL INDUSTRIES OF SACRAMENTO VALLEY & NORTHERN NEVADA, INC. MEDICAL, DENTAL AND VISION PLAN [EIN = 941201202]
• GOODWILL INDUSTRIES OF MICHIANA, INC. FLEXIBLE BEN [EIN = 351093073]
• GOODWILL INDUSTRIES OF THE SOUTHERN PIEDMONT, INC. RETIREMENT PLAN [EIN = 560844639]
• GOODWILL INDUSTRIES OF SW FLORIDA, INC. WELFARE BENEFITS PLAN [EIN = 596196141]
• GOODWILL INDUSTRIES OF THE GULF COAST, INC. HEALTH AND WELFARE PLAN [EIN = 630363472]
• GOODWILL INDUSTRIES OF SOUTHEASTERN WISCONSIN, INC. 403(B) PLAN [EIN = 390808491]
• GOODWILL INDUSTRIES OF SAN FRANCISCO, SAN MATEO, AND MARIN COUNTIES, INC. 403(B) PLAN [EIN = 941156540]
• GOODWILL INDUSTRIES OF NORTH CENTRAL WISCONSIN, INC. LIFE AND DISABILITY PLAN [EIN = 391144913]
• GOODWILL INDUSTRIES OF NORTHEAST TEXAS, INC. 401(K) PLAN [EIN = 751517836]
• GOODWILL INDUSTRIES OF MID MICHIGAN, INC. [EIN = 381358009]
• GOODWILL INDUSTRIES EMPLOYEE RETIREMENT PLAN [EIN = 586046795]
• GOODWILL INDUSTRIES EMPLOYEE SAVINGS PLAN [EIN = 910597006]
• GOODWILL INDUSTRIES OF SANTA CLARA COUNTY DEFINED BENEFIT PENSION PLAN [EIN = 941212132]
• GOODWILL INDUSTRIES OF SOUTHWESTERN MICHIGAN INC. [EIN = 381558550]
• GOODWILL INDUSTRIES OF NORTHERN NEW ENGLAND EMPLOYEE MEDICAL BENEFIT PLAN [EIN = 010284340]
• GOODWILL INDUSTRIES OF CENTRAL FLORIDA HEALTH & WELFARE PLAN [EIN = 590908166]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL CALIFORNIA HEALTH AND WELFARE PLAN [EIN = 770129283]
• GOODWILL INDUSTRIES OF HOUSTON, INC PROFIT SHARING RETIREMENT PLAN [EIN = 741285095]
• GOODWILL INDUSTRIES OF LANE & SOUTH COAST COUNTIES 403B PLAN [EIN = 930572370]
• GOODWILL INDUSTRIES OF WESTERN NEW YORK, INC. PENSION TRUST PLAN [EIN = 160761225]
• GOODWILL INDUSTRIES INSURANCE PLAN [EIN = 530196517]
• GOODWILL INDUSTRIES OF NORTH FLORIDA HOURLY PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES OF NORTH GEORGIA, INC TAX DEFERRED ANNUITY PLAN [EIN = 580566193]
• GOODWILL INDUSTRIES FLEXIBLE SPENDING ACCOUNT [EIN = 410706171]
• GOODWILL INDUSTRIES OF NORTH FLORIDA LIFE INSURANCE PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES OF WEST MICHIGAN INC EMPLOYEE PENSION PLAN [EIN = 381357148]
• GOODWILL INDUSTRIES OF CENTRAL ILLINOIS, INC. SAFE HARBOR 401(K) PLAN [EIN = 370673521]
• GOODWILL INDUSTRIES OF MONOCACY VALLEY, INC. DISABILITY PLAN [EIN = 237047548]
• GOODWILL INDUSTRIES OF SOUTHWEST OKLAHOMA & NORTH TEXAS 403(B) PLAN [EIN = 730675119]
• GOODWILL INDUSTRIES, EASTER SEALS OF THE GULF COAST RETIREMENT PLAN [EIN = 630363472]
• GOODWILL INDUSTRIES OF MIDDLE TENNESSEE RETIREMENT [EIN = 620599413]
• GOODWILL INDUSTRIES OF DELAWARE & DELAWARE COUNTY EMPLOYEE BENEFIT PLAN [EIN = 510064311]
• GOODWILL INDUSTRIES OF NORTH FLORIDA DENTAL PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL WISCONSIN INC. DENTAL PLAN [EIN = 391147571]
• GOODWILL INDUSTRIES OF CENTRAL FLORIDA, INC. PROFIT SHARING PLAN [EIN = 590908166]
• GOODWILL INDUSTRIES OF NEW MEXICO PREMIER PLAN 5000 [EIN = 850107916]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL WISCONSIN INC. HEALTH PLAN [EIN = 391147571]
• GOODWILL INDUSTRIES OF DALLAS, INC. TAX DEFERRED ANNUITY [EIN = 750800649]
• GOODWILL INDUSTRIES EMPLOYEE RETIREMENT AND INCENTIVE PLAN [EIN = 930386840]
• GOODWILL INDUSTRIES KEYSTONE AREA WELFARE BENEFIT PLAN [EIN = 231365338]
• GOODWILL INDUSTRIES OF HAWAII, INC. MEDICAL AND DENTAL INSURANCE [EIN = 996001264]
• GOODWILL INDUSTRIES OF SOUTHERN CALIFORNIA WELFARE PLAN [EIN = 951641441]
• GOODWILL INDUSTRIES OF WAYNE AND HOLMES COUNTIES INC. 403B RETIREMENT PLAN [EIN = 341272032]
• GOODWILL INDUSTRIES OF N.E. INDIANA EMPLOYEE GROUP HEALTH PLAN [EIN = 351905018]
• GOODWILL INDUSTRIES OF SOUTHERN NEVADA HEALTH AND WELFARE PLAN [EIN = 237437479]
• GOODWILL INDUSTRIES OF KANAWHA VALLEY 401(K) PLAN [EIN = 550380828]
• GOODWILL INDUSTRIES RETIREMENT SAVINGS PLAN [EIN = 586035822]
• GOODWILL INDUSTRIES OF SOUTHERN CALIFORNIA, INC 403(B) THRIFT PLAN [EIN = 951641441]
• GOODWILL INDUSTRIES OF THE SOUTHERN RIVERS, INC. HEALTH [EIN = 586035822]
• GOODWILL INDUSTRIES OF NORTH FLORIDA LONG TERM DISABILITY PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES HEALTH AND WELFARE PLAN [EIN = 910597006]
• GOODWILL INDUSTRIES OF SAN JOAQUIN VALLEY, INC. 401K RETIREMENT PLAN [EIN = 941366601]
• GOODWILL INDUSTRIES OF NORTH CENTRAL WISCONSIN, INC. 403(B) RETIREMENT PLAN [EIN = 391144913]
• GOODWILL INDUSTRIES-KNOXVILLE, INC. TAX SHELTERED ANNUITY PLAN [EIN = 620868796]
• GOODWILL INDUSTRIES OF NORTHEAST INDIANA, INC. 401(K) PLAN [EIN = 351905018]
• GOODWILL INDUSTRIES OF WNY, INC HEALTH INSURANCE CAFETERIA PLAN FOR EMPLOYEES [EIN = 160761225]
• GOODWILL INDUSTRIES-MANASOTA, INC. PREMIUM PAYMENT PLAN [EIN = 592074391]
• GOODWILL INDUSTRIES OF NW OHIO INC TAX DEFERRED ANNUITY PLAN [EIN = 344434288]
• GOODWILL INDUSTRIES OF SOUTHERN ARIZONA, INC. 403(B) PLAN [EIN = 860223401]
• GOODWILL INDUSTRIES OF CENTRAL NC WELFARE BENEFITS PLAN [EIN = 560862842]
• GOODWILL INDUSTRIES OF SE WI, INC. [EIN = 390808491]
• GOODWILL INDUSTRIES OF GREATER NY & NORTHERN NJ, INC. 403(B) PLAN [EIN = 131641068]
• GOODWILL INDUSTRIES HEALTH, LIFE AND SHORT TERM DISABILITY PLAN [EIN = 840405513]
• GOODWILL INDUSTRIES OF SOUTHERN ARIZONA INC EMPLOYEE WELFARE BENEFIT PLAN [EIN = 860223401]
• GOODWILL INDUSTRIES OF SACRAMENTO VALLEY & NORTHERN NEVADA, INC. LIFE PLAN [EIN = 941201202]
• GOODWILL INDUSTRIES OF HAWAII, INC. HEALTH & WELFARE RETIREMENT PLAN & TRUST [EIN = 996001264]
• GOODWILL INDUSTRIES OF THE COLUMBIA WILLAMETTE HEALTH PLAN [EIN = 930386840]
• GOODWILL INDUSTRIES OF SAN ANTONIO THRIFT PLAN [EIN = 741238444]
• GOODWILL INDUSTRIES OF NE IOWA, INC. HEALTH INSURANCE PLAN [EIN = 420839399]
• GOODWILL INDUSTRIES OF MIDDLE TENNESSEE, INC. EMPLOYEE BENEFIT PLAN [EIN = 620599413]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL WISCONSIN, INC. WRAP PLAN [EIN = 391147571]
• GOODWILL INDUSTRIES OF THE VALLEYS EMPLOYEE HEALTH & WELFARE PLAN [EIN = 540884014]
• GOODWILL INDUSTRIES OF GREATER GRAND RAPIDS, INC. 125 BENEFIT PLAN [EIN = 386113049]
• GOODWILL INDUSTRIES OF SAN ANTONIO CONTRACT SERVIC HEALTH AND WELFARE PLAN [EIN = 460688991]
• GOODWILL INDUSTRIES OF CENTRAL ARIZONA RETIREMENT PLAN [EIN = 860104415]
• GOODWILL INDUSTRIES OF ARKANSAS LTD PLAN [EIN = 710236903]
• GOODWILL INDUSTRIES OF KENTUCKY FLEXIBLE BENEFITS PLAN [EIN = 610475284]
• GOODWILL INDUSTRIES OF NORTH FLORIDA VISION PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES OF FORT WORTH, INC. DBA GOODWILL NORTH CENTRAL TEXAS HEALTH AND WELFARE PLAN [EIN = 750868393]
• GOODWILL INDUSTRIES INTERNATIONAL MEDICAL PLAN [EIN = 530196517]
• GOODWILL INDUSTRIES OF SAN DIEGO COUNTY WELFARE BENEFITS PLAN [EIN = 951652910]
• GOODWILL INDUSTRIES OF N.E. PA, INC 401K PLAN [EIN = 240800938]
• GOODWILL INDUSTRIES OF CENTRAL INDIANA, INC. DISCRETIONARY CONTRIBUTION THRIFT PLAN [EIN = 350893506]
• GOODWILL INDUSTRIES OF KANSAS, INC. EMPLOYEE BENEFIT PLAN [EIN = 480673284]
• GOODWILL INDUSTRIES OF THE HEARTLAND DENTAL EXPENSE PLAN [EIN = 420923563]
• GOODWILL INDUSTRIES, INC. OMAHA RETIREMENT PLAN [EIN = 470378996]
• GOODWILL INDUSTRIES OF CENTRAL MICHIGAN'S HEARTLAND 401(K) PLAN [EIN = 381426892]
• GOODWILL INDUSTRIES OF CENTRAL ARIZONA INC HEALTH & WELFARE PLAN [EIN = 860104415]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL WI, INC. 401(K) PLAN [EIN = 391147571]
• GOODWILL INDUSTRIES OF NORTH FLORIDA MEDICAL PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES OF CENTRAL FLORIDA INC WELFARE BENEFITS PLAN [EIN = 590908166]
• GOODWILL INDUSTRIES OF ACADIANA INC WELFARE BENEFIT PLAN [EIN = 721179550]
• GOODWILL INDUSTRIES OF NEW MEXICO 403(B) PLAN [EIN = 850107916]
• GOODWILL INDUSTRIES OF DELAWARE & DELAWARE COUNTY, INC. 401(K) PLAN [EIN = 510064311]
• GOODWILL INDUSTRIES OF NORTHERN WISCONSIN AND UPPER MICHIGAN, INC. [EIN = 391049987]
• GOODWILL INDUSTRIES OF CENTRAL FLORIDA 403(B) PLAN [EIN = 590908166]
• GOODWILL INDUSTRIES-MANASOTA, INC. RETIREMENT PLAN [EIN = 592074391]
• GOODWILL INDUSTRIES OF DALLAS, INC. DENTAL/VISION [EIN = 750800649]
• GOODWILL INDUSTRIES OF UPSTATE/MIDLANDS SC, INC WELFARE BENEFIT PLAN [EIN = 570564001]
• GOODWILL INDUSTRIES OF SOUTHERN NEW JERSEY WELFARE PLAN [EIN = 210681239]
• GOODWILL INDUSTRIES OF SOUTHWESTERN MICHIGAN INC. [EIN = 381558550]
• GOODWILL INDUSTRIES LIFE AND DISABILITY PLAN [EIN = 741238444]
• GOODWILL INDUSTRIES OF CENTRAL TEXAS 403(B) TDA PLAN [EIN = 741322808]
• GOODWILL INDUSTRIES OF EASTERN NORTH CAROLINA, INC. LIFE/AD&D & DISABILITY PLAN [EIN = 560861003]
• GOODWILL INDUSTRIES OF HOUSTON EMPLOYEE BENEFITS PLAN [EIN = 741285095]
• GOODWILL INDUSTRIES OF ARKANSAS, INC. 403(B) PLAN [EIN = 710236903]
• GOODWILL INDUSTRIES OF ORANGE COUNTY EMPLOYEE BENEFIT PLAN [EIN = 951644018]
• GOODWILL INDUSTRIES OF MONOCACY VALLEY, INC. HEALTH PLAN [EIN = 237047548]
• GOODWILL INDUSTRIES OF CENTRAL OKLAHOMA HEALTH & WELFARE PLAN [EIN = 730641590]
• GOODWILL INDUSTRIES OF DALLAS, INC. HEALTH (PPO) [EIN = 750800649]
• GOODWILL INDUSTRIES OF THE REDWOOD EMPIRE EMPLOYEE BENEFIT PLAN [EIN = 942237862]
• GOODWILL INDUSTRIES OF NORTHWEST NORTH CAROLINA INC GROUP BENEFIT PLAN [EIN = 560588474]
• GOODWILL INDUSTRIES OF N.E. IOWA, INC. 401(K) PROFIT SHARING PLAN [EIN = 420839399]
• GOODWILL INDUSTRIES LIFE INSURANCE [EIN = 410706171]
• GOODWILL INDUSTRIES 401(K) & PROFIT SHARING PLAN [EIN = 386113094]
• GOODWILL INDUSTRIES OF THE COASTAL EMPIRE, INC. FLEXIBLE BENEFITS PLAN [EIN = 586046795]
• GOODWILL INDUSTRIES OF LOWER SC, INC. 401K PLAN [EIN = 570632511]
• GOODWILL INDUSTRIES OF SOUTH FLORIDA INC 401(K) PLAN [EIN = 590866126]
• GOODWILL INDUSTRIES OF NE IOWA, INC. DENTAL PLAN [EIN = 420839399]
• GOODWILL INDUSTRIES OF CENTRAL NORTH CAROLINA, INC. 401K PLAN [EIN = 560862842]
• GOODWILL INDUSTRIES OF WNY GROUP INSURANCE PLAN [EIN = 160761225]
• GOODWILL INDUSTRIES OF NORTHERN ARIZONA 403(B) PL N [EIN = 860280491]
• GOODWILL INDUSTRIES OF NORTH LOUISIANA HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 720460816]
• GOODWILL INDUSTRIES OF TENNEVA AREA INC. [EIN = 237217515]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL VIRGINIA, INC. 401(B) PLAN [EIN = 237190326]
• GOODWILL INDUSTRIES OF LORAIN COUNTY INC. 401(K) LAN [EIN = 340714739]
• GOODWILL INDUSTRIES HOUSING COMPANY, INC. 401(K) PLAN [EIN = 112224215]
• GOODWILL INDUSTRIES OF LOWER SC, INC. 403B PLAN [EIN = 570632511]
• GOODWILL INDUSTRIES OF FORT WORTH HEALTH & WELFARE TRUST [EIN = 750868393]
• GOODWILL INDUSTRIES KANSAS EASTER SEAL HEALTH & WELFARE TRUST [EIN = 480673284]
• GOODWILL INDUSTRIES EL PASO HEALTH & WELFARE TRUST [EIN = 741234166]
• GOODWILL INDUSTRIES OF SOUTH TEXAS RETIREMENT PLAN [EIN = 741223056]
• GOODWILL INDUSTRIES OF THE COASTAL EMPIRE, INC. HEALTH & WELFARE PLAN [EIN = 586046795]
• GOODWILL INDUSTRIES OF N.E. IOWA, INC. UNION 401(K) PLAN [EIN = 420839399]
• GOODWILL INDUSTRIES OF RHODE ISLAND RETIREMENT PLAN [EIN = 050258845]
• GOODWILL INDUSTRIES OF THE COLUMBIA INC 401K PROFIT SHARING PLAN [EIN = 237071436]
• GOODWILL INDUSTRIES OF SW OKLAHOMA HEALTH & WELFARE TRUST [EIN = 730675119]
• GOODWILL INDUSTRIES OF NORTH LOUISIANA, INC. CAFETERIA PLAN [EIN = 720460816]
• GOODWILL INDUSTRIES-MANASOTA, INC. TSA RETIREMENT PLAN [EIN = 592074391]
• GOODWILL INDUSTRIES OF KENTUCKY, INC. EMPLOYEE HEALTH CARE PLAN [EIN = 610475284]
• GOODWILL INDUSTRIES OF GREATER NE, INC. EMPLOYEE RETIREMENT PLAN [EIN = 470522836]
• GOODWILL INDUSTRIES OF CENTRAL ARIZONA, INC. 403(B) PLAN [EIN = 860104415]
• GOODWILL INDUSTRIES SERVING SOUTHEAST NEBRASKA, INC. DEFINED CONTRIBUTION RETIREMENT PLAN [EIN = 470376582]
• GOODWILL INDUSTRIES OF UPPER SC, INC 401(K) PLAN [EIN = 570564001]
• GOODWILL INDUSTRIES OF HAWAII, INC. 401K RETIREMENT SAVINGS PLAN [EIN = 996001264]
• GOODWILL INDUSTRIES 401(K) & PROFIT SHARING PLAN [EIN = 386113049]
• GOODWILL INDUSTRIES OF CENTRAL FLORIDA HEALTH [EIN = 590908166]
• GOODWILL INDUSTRIES OF CENTRAL IOWA [EIN = 420764469]
• GOODWILL INDUSTRIES CAFETERIA PLAN - GROUP LIFE [EIN = 560588474]
• GOODWILL INDUSTRIES - BIG BEND, INC. [EIN = 591279499]
• GOODWILL INDUSTRIES OF KENTUCKY INC GROUP HEALTH & WELFARE BENEFIT PLAN [EIN = 610475284]
• GOODWILL INDUSTRIES OF SAN ANTONIO HEALTH & WELFARE PLAN [EIN = 741234888]
• GOODWILL INDUSTRIES / EASTER SEAL RETIREMENT PROFIT SHARING PLAN [EIN = 410706171]
• GOODWILL INDUSTRIES OF NORTH GEORGIA, INC TAX DEFERRED ANNUITY PLAN [EIN = 208351046]
• GOODWILL INDUSTRIES OF LOWER SOUTH CAROLINA, INC. HEALTH & WELFARE PLAN [EIN = 570632511]
• GOODWILL INDUSTRIES OF CENTRAL TEXAS WRAP PLAN [EIN = 741322808]
• GOODWILL INDUSTRIES OF THE COLUMBIA WILLAMETTE LIFE & DISABILITY PLAN [EIN = 930386840]
• GOODWILL INDUSTRIES OF SOUTH TX FLEXACCOUNT PLAN [EIN = 741223056]
• GOODWILL INDUSTRIES EMPLOYEE INJURY BENEFIT PLAN [EIN = 750800649]
• GOODWILL INDUSTRIES OF NORTH GEORGIA [EIN = 580566193]
• GOODWILL INDUSTRIES OF GREATER CLEVELAND AND ECO WBP [EIN = 340909974]
• GOODWILL INDUSTRIES LIFE INSURANCE PLAN [EIN = 840405513]
• GOODWILL INDUSTRIES OF THE COLUMBIA WILLAMETTE DENTAL PLAN [EIN = 930386840]
• GOODWILL INDUSTRIES FLEXIBLE BENEFITS PLAN [EIN = 941366601]
• GOODWILL INDUSTRIES OF SAN ANTONIO HEALTH AND WELFARE PLANS [EIN = 741238444]
• GOODWILL INDUSTRIES OF SOUTHERN NEW JERSEY & PHILADELPHIA VISION PLAN [EIN = 210681239]
• GOODWILL INDUSTRIES OF SOUTHEASTERN WISCONSIN, INC HEALTH & WELFARE PLAN [EIN = 390808491]
• GOODWILL INDUSTRIES OF NORTH FLORIDA 5500 WRAP PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES OF MONOCACY VALLEY, INC. 401(K) PLAN [EIN = 237047548]
• GOODWILL INDUSTRIES OF THE CHESAPEAKE INC EMPLOYEE BENEFITS PLAN [EIN = 520591576]
• GOODWILL INDUSTRIES OF WESTERN NEW YORK 403(B) PLAN [EIN = 160761225]
• GOODWILL INDUSTRIES OF NW NC, INC. MPP [EIN = 560588474]
• GOODWILL INDUSTRIES OF NORTHERN NEW ENGLAND GROUP LIFE/AD&D BENEFIT [EIN = 010284340]
• GOODWILL INDUSTRIES OF ERIE, HURON, OTTAWA AND SANDUSKY COUNTIES, INC. 401(K) PLAN [EIN = 341113714]
• GOODWILL INDUSTRIES SOUTHERN NJ & PHILADELPHIA LIFE, AD&D, LTD & STD PLAN [EIN = 210681239]
• GOODWILL INDUSTRIES OF NORTH FLORIDA RETIREMENT SAVINGS PLAN [EIN = 590637858]
• GOODWILL INDUSTRIES OF EAST TEXAS HEALTH AND WELFARE PLAN [EIN = 751478918]
• GOODWILL INDUSTRIES OF NORTHERN MICHIGAN HEALTH [EIN = 381976268]
• GOODWILL INDUSTRIES OF NORTHWEST NC 403(B) PLAN [EIN = 560588474]
• GOODWILL INDUSTRIES OF SOUTHEASTERN WISCONSIN, INC. EAP PLAN [EIN = 390808491]
• GOODWILL INDUSTRIES INTERNATIONAL BENEFIT PLAN [EIN = 530196517]
• GOODWILL INDUSTRIES OF SOUTH CENTRAL VIRGINIA, INC. HEALTH AND WELFARE PLAN [EIN = 237190326]
• GOODWILL INDUSTRIES OF MID MICHIGAN [EIN = 381358009]
• GOODWILL INDUSTRIES OF NORTHWEST TEXAS 401(K) PLAN [EIN = 741245440]
• GOODWILL INDUSTRIES OF DALLAS, INC. HEALTH PLAN [EIN = 750800649]
• GOODWILL INDUSTRIES OF NORTHERN ARIZONA 401(K) PLAN [EIN = 860280491]
• GOODWILL INDUSTRIES OF THE HEARLAND VISION EXPENSE PLAN [EIN = 420923563]
• GOODWILL INDUSTRIES INTERNATIONAL, INC. HEALTH AND WELFARE PLAN [EIN = 530196517]
• GOODWILL INDUSTRIES VISION PLAN [EIN = 741322808]
• GOODWILL INDUSTRIES MEDICAL/FSA [EIN = 741322808]
• GOODWILL INDUSTRIES OF THE VALLEYS WELFARE PLAN [EIN = 540884014]
• GOODWILL INDUSTRIES OF WEST MICHIGAN INC EMPLOYEE PENSION PLAN [EIN = 381357148]
• GOODWILL INDUSTRIES OF CENTRAL FL AETNA BEHAVIORAL HEALTH LLC [EIN = 590908166]
• GOODWILL INDUSTRIES OF NE IOWA, INC. HEALTH INSURANCE PLAN [EIN = 430839399]
• GOODWILL INDUSTRIES OF CENTRAL FLORIDA COLONIAL [EIN = 590908166]
• GOODWILL INDUSTRIES DENTAL, LIFE, AND ADD PLAN [EIN = 741322808]
• GOODWILL INDUSTRIES OF SOUTHWESTERN MICHIGAN INC. [EIN = 381558550]
• GOODWILL INDUSTRIES OF SOUTHERN ARIZONA INC GROUP LIFE AND DISABILITY PLAN [EIN = 860223401]
• GOODWILL INDUSTRIES OF NORTH GEORGIA, INC. HEALTH AND WELFARE PLAN [EIN = 580566193]
• GOODWILL INDUSTRIES OF NE TX FLEXACCOUNT PLAN [EIN = 751517836]
• GOODWILL INDUSTRIES, INC. OMAHA RETIREMENT PLAN [EIN = 470378996]
• GOODWILL INDUSTRIES OF SOUTHERN ARIZONA INC GROUP DENTAL PLAN [EIN = 860223401]
• GOODWILL INDUSTRIES OF THE GREATER EAST BAY GROUP WELFARE PLAN [EIN = 941186175]
• GOODWILL INDUSTRIES OF HAWAII, INC. 401(K) RETIREMENT SAVINGS PLAN [EIN = 996001264]
• GOODWILL INDUSTRIES OF NORTH LOUISIANA, INC. INSURANCE PLAN [EIN = 720460816]
• GOODWILL INDUSTRIES VSB 401(K) PLAN [EIN = 770448301]
• GOODWILL INDUSTRIES OF N IL EMPLOYEE LIFE, ADD, LTD, STD [EIN = 362167846]
• GOODWILL INDUSTRIES OF THE PIONEER VALLEY, INC. 401(K) PLAN [EIN = 042131758]
• GOODWILL INDUSTRIES OF MONOCACY VALLEY 401(K) PLAN [EIN = 237047548]
• GOODWILL INDUSTRIES OF THE COLUMBIA INC 403(B) PLAN [EIN = 237071436]
• GOODWILL INDUSTRIES OF SOUTHEASTERN WISCONSIN INC. & GREAT LAKES RESOURCES INC. SCA RETIREMENT PLAN [EIN = 010786169]
• GOODWILL INDUSTRIES OF SOUTHEASTERN WISCONSIN INC. & GREAT LAKES RESOURCES INC. SCA RETIREMENT PLAN [EIN = 390808491]
• GOODWILL INDUSTRIES OF WEST MICHIGAN, INC. WELFARE BENEFIT PLAN [EIN = 381357148]
• GOODWILL INDUSTRIES OF N.E. PA, INC . EMPLOYEE BENEFIT PLAN [EIN = 240800938]
• GOODWILL INDUSTRIES, INC. EMPLOYEE BENEFIT PLAN [EIN = 410706171]
• GOODWILL INDUSTRIES 401(K) PLAN [EIN = 630522335]
• GOODWILL INDUSTRIES OF SOUTH FLORIDA WRAP PLAN [EIN = 590866126]
• GOODWILL INDUSTRIES OF NORTHWEST OHIO, INC. 403(B) PLAN [EIN = 344434288]
• GOODWILL INDUSTRIES OF NORTHEASTERN PENNSYLVANIA, INC. GROUP INSURANCE PLAN [EIN = 240800938]
• GOODWILL INDUSTRIES OF THE COLUMBIA GROUP BENEFITS PLAN [EIN = 237071436]
• GOODWILL INDUSTRIES OF MID MICHIGAN [EIN = 381358009]
• GOODWILL INDUSTRIES OF VENTURA AND SANTA BARBARA MEDICAL PLAN [EIN = 770448301]
• GOODWILL INDUSTRIES OF SOUTH MISSISSIPPI, INC. LIFE AND DENTAL BENEFITS PLAN [EIN = 640547585]
• GOODWILL INDUSTRIES OF GREATER DETROIT HEALTH & WELFARE PLAN [EIN = 381362823]
• GOODWILL INDUSTRIES OF SACRAMENTO VALLEY AND NORTHERN NEVADA EMPLOYEE BENEFIT PLAN [EIN = 941201202]
• GOODWILL INDUSTRIES OF NORTHERN ILLINOIS AND WISCONSIN STATELINE AREA LONG TERM DISABILITY PLAN [EIN = 362167846]
• GOODWILL INDUSTRIES OF NORTHERN ILLINOIS AND WISCONSIN STATELINE AREA SHORT TERM DISABILITY PLAN [EIN = 362167846]
• GOODWILL INDUSTRIES OF NORTHERN ILLINOIS AND WISCONSIN STATELINE AREA DENTAL PLAN [EIN = 362167846]
• GOODWILL INDUSTRIES-BIG BEND, INC. GROUP INSURANCE PLAN (502) [EIN = 591279499]
• GOODWILL INDUSTRIES OF SOUTH MISSISSIPPI, INC. HEALTH BENEFIT PLAN [EIN = 640547585]
• GOODWILL INDUSTRIES OF TENNEVA INC EMPLOYEE BENEFITS PLAN [EIN = 237217515]
• GOODWILL INDUSTRIES VOCATIONAL ENTERPRISES, INC. EMPLOYEE BENEFITS PLAN [EIN = 410919602]
• GOODWILL INDUSTRIES, INC HEALTH AND WELFARE PLAN [EIN = 410706171]
• GOODWILL INDUSTRIES OF SE LOUISIANA EMPLOYEE BENEFIT PLAN [EIN = 720546906]
• GOODWILL INDUSTRIES OF SE LOUISIANA MEDICAL PLAN [EIN = 720546906]
• GOODWILL INDUSTRIES OF SE LOUISIANA VISION PLAN [EIN = 720546906]
• GOODWILL INDUSTRIES OF SE LOUISIANA BASIC LIFE PLAN [EIN = 720546906]
• GOODWILL INDUSTRIES OF SE LOUISIANA ACCIDENT PLAN [EIN = 720546906]
• GOODWILL INDUSTRIES OF NORTHWEST TEXAS MEDICAL BENEFIT PLAN [EIN = 751245440]
• GOODWILL INDUSTRIES OF NORTHWEST TEXAS LIFE AND AD&D BENEFIT PLAN [EIN = 751245440]