401k Plan data: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN plan

MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 401k Plan overview

Plan Name	MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN
Plan identification number	502

MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover

401k Sponsoring company profile

MERCHANTS & MARINE BANK has sponsored the creation of one or more 401k plans.

Company Name: MERCHANTS & MARINE BANK

Employer identification number (EIN): 646016232

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 CASEY HILL 2023-07-05
502 2021-01-01 CASEY HILL 2022-07-27
502 2020-01-01 CASEY HILL 2021-07-28
502 2019-01-01 L. ROYCE CUMBEST 2020-07-06
502 2018-01-01
502 2017-01-01
502 2016-01-01
502 2015-01-01 DONNA W BRUCE
502 2014-01-01 DONNA W BRUCE
502 2014-01-01 DONNA W BRUCE
502 2013-01-01 DONNA W BRUCE
502 2012-01-01 DONNA W BRUCE
502 2011-01-01 L. ROYCE CUMBEST L. ROYCE CUMBEST 2012-10-15
502 2009-01-01 L. ROYCE CUMBEST L. ROYCE CUMBEST 2010-10-14
502 2009-01-01 L. ROYCE CUMBEST L. ROYCE CUMBEST 2010-10-14
502 2009-01-01 L. ROYCE CUMBEST L. ROYCE CUMBEST 2010-10-05
502 2009-01-01 L. ROYCE CUMBEST L. ROYCE CUMBEST 2010-10-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2022-01-01	CASEY HILL	2023-07-05
502	2021-01-01	CASEY HILL	2022-07-27
502	2020-01-01	CASEY HILL	2021-07-28
502	2019-01-01	L. ROYCE CUMBEST	2020-07-06
502	2018-01-01
502	2017-01-01
502	2016-01-01
502	2015-01-01	DONNA W BRUCE
502	2014-01-01	DONNA W BRUCE
502	2014-01-01	DONNA W BRUCE
502	2013-01-01	DONNA W BRUCE
502	2012-01-01	DONNA W BRUCE
502	2011-01-01	L. ROYCE CUMBEST		L. ROYCE CUMBEST	2012-10-15
502	2009-01-01	L. ROYCE CUMBEST		L. ROYCE CUMBEST	2010-10-14
502	2009-01-01	L. ROYCE CUMBEST		L. ROYCE CUMBEST	2010-10-14
502	2009-01-01	L. ROYCE CUMBEST		L. ROYCE CUMBEST	2010-10-05
502	2009-01-01	L. ROYCE CUMBEST		L. ROYCE CUMBEST	2010-10-05

Plan Statistics for MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN

401k plan membership statisitcs for MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN

Measure Date Value
2022: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 153
Total of all active and inactive participants 2022-01-01 153
Total participants 2022-01-01 153
2021: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 145
Total of all active and inactive participants 2021-01-01 145
Total participants 2021-01-01 145
2020: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 133
Total of all active and inactive participants 2020-01-01 133
Total participants 2020-01-01 133
2019: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 144
Total of all active and inactive participants 2019-01-01 144
Total participants 2019-01-01 144
2018: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 145
Total of all active and inactive participants 2018-01-01 145
Total participants 2018-01-01 145
2017: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 128
Total of all active and inactive participants 2017-01-01 128
Total participants 2017-01-01 128
2016: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 128
Total of all active and inactive participants 2016-01-01 128
Total participants 2016-01-01 128
2015: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 131
Total of all active and inactive participants 2015-01-01 131
Total participants 2015-01-01 131
2014: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 140
Total of all active and inactive participants 2014-01-01 129
Total participants 2014-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 129
2013: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 140
Total of all active and inactive participants 2013-01-01 140
Total participants 2013-01-01 140
2012: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 143
Total of all active and inactive participants 2012-01-01 143
Total participants 2012-01-01 143
2011: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 126
Total of all active and inactive participants 2011-01-01 126
2009: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 133
Total of all active and inactive participants 2009-01-01 133

Measure	Date	Value
2022: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	153
Total of all active and inactive participants	2022-01-01	153
Total participants	2022-01-01	153
2021: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	145
Total of all active and inactive participants	2021-01-01	145
Total participants	2021-01-01	145
2020: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	133
Total of all active and inactive participants	2020-01-01	133
Total participants	2020-01-01	133
2019: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	144
Total of all active and inactive participants	2019-01-01	144
Total participants	2019-01-01	144
2018: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	145
Total of all active and inactive participants	2018-01-01	145
Total participants	2018-01-01	145
2017: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	128
Total of all active and inactive participants	2017-01-01	128
Total participants	2017-01-01	128
2016: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	128
Total of all active and inactive participants	2016-01-01	128
Total participants	2016-01-01	128
2015: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	131
Total of all active and inactive participants	2015-01-01	131
Total participants	2015-01-01	131
2014: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	140
Total of all active and inactive participants	2014-01-01	129
Total participants	2014-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	129
2013: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	140
Total of all active and inactive participants	2013-01-01	140
Total participants	2013-01-01	140
2012: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	143
Total of all active and inactive participants	2012-01-01	143
Total participants	2012-01-01	143
2011: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	126
Total of all active and inactive participants	2011-01-01	126
2009: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	133
Total of all active and inactive participants	2009-01-01	133

Form 5500 Responses for MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN

2022: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: MERCHANTS & MARINE BANK LONG-TERM DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0AZXM

Policy instance

Insurance contract or identification number	GUDE0AZXM
Number of Individuals Covered	18
Insurance policy start date	2021-05-01
Insurance policy end date	2022-05-01
Total amount of commissions paid to insurance broker	USD $398
Total amount of fees paid to insurance company	USD $20
Other welfare benefits provided	CI VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $2,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $398
Amount paid for insurance broker fees	20
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0AZXM

Policy instance

Insurance contract or identification number	GUDH0AZXM
Number of Individuals Covered	22
Insurance policy start date	2021-05-01
Insurance policy end date	2022-05-01
Total amount of commissions paid to insurance broker	USD $841
Total amount of fees paid to insurance company	USD $40
Other welfare benefits provided	ACCIDENT VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $5,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $841
Amount paid for insurance broker fees	40
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AZXM

Policy instance

Insurance contract or identification number	GVTL0AZXM
Number of Individuals Covered	50
Insurance policy start date	2021-05-01
Insurance policy end date	2022-05-01
Total amount of commissions paid to insurance broker	USD $2,055
Total amount of fees paid to insurance company	USD $120
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $13,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,055
Amount paid for insurance broker fees	120
Additional information about fees paid to insurance broker	AGENT OR BROKER RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AZXM

Policy instance

Insurance contract or identification number	GLTD0AZXM
Number of Individuals Covered	110
Insurance policy start date	2021-05-01
Insurance policy end date	2022-05-01
Total amount of commissions paid to insurance broker	USD $3,285
Total amount of fees paid to insurance company	USD $173
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,285
Amount paid for insurance broker fees	173
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0AZXM

Policy instance

Insurance contract or identification number	GUG 0AZXM
Number of Individuals Covered	110
Insurance policy start date	2021-05-01
Insurance policy end date	2022-05-01
Total amount of commissions paid to insurance broker	USD $3,780
Total amount of fees paid to insurance company	USD $209
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $25,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,780
Amount paid for insurance broker fees	209
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AZXM

Policy instance

Insurance contract or identification number	GLUG0AZXM
Number of Individuals Covered	153
Insurance policy start date	2021-05-01
Insurance policy end date	2022-05-01
Total amount of commissions paid to insurance broker	USD $7,892
Total amount of fees paid to insurance company	USD $414
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $52,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,892
Amount paid for insurance broker fees	414
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AZXM

Policy instance

Insurance contract or identification number	GLUG0AZXM
Number of Individuals Covered	145
Insurance policy start date	2020-05-01
Insurance policy end date	2021-05-01
Total amount of commissions paid to insurance broker	USD $6,441
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $42,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,441
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0AZXM

Policy instance

Insurance contract or identification number	GUG 0AZXM
Number of Individuals Covered	114
Insurance policy start date	2020-05-01
Insurance policy end date	2021-05-01
Total amount of commissions paid to insurance broker	USD $3,901
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $26,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,901
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AZXM

Policy instance

Insurance contract or identification number	GLTD0AZXM
Number of Individuals Covered	145
Insurance policy start date	2020-05-01
Insurance policy end date	2021-05-01
Total amount of commissions paid to insurance broker	USD $2,652
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,652
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AZXM

Policy instance

Insurance contract or identification number	GVTL0AZXM
Number of Individuals Covered	54
Insurance policy start date	2020-05-01
Insurance policy end date	2021-05-01
Total amount of commissions paid to insurance broker	USD $2,372
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $15,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,372
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0AZXM

Policy instance

Insurance contract or identification number	GUDH0AZXM
Number of Individuals Covered	18
Insurance policy start date	2020-05-01
Insurance policy end date	2021-05-01
Total amount of commissions paid to insurance broker	USD $724
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $4,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $724
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0AZXM

Policy instance

Insurance contract or identification number	GUDE0AZXM
Number of Individuals Covered	15
Insurance policy start date	2020-05-01
Insurance policy end date	2021-05-01
Total amount of commissions paid to insurance broker	USD $464
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CI VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $3,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $464
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AZXM

Policy instance

Insurance contract or identification number	GLUG0AZXM
Number of Individuals Covered	133
Insurance policy start date	2019-05-01
Insurance policy end date	2020-05-01
Total amount of commissions paid to insurance broker	USD $5,983
Total amount of fees paid to insurance company	USD $1,229
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $39,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,983
Amount paid for insurance broker fees	1229
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0AZXM

Policy instance

Insurance contract or identification number	GUG 0AZXM
Number of Individuals Covered	115
Insurance policy start date	2019-05-01
Insurance policy end date	2020-05-01
Total amount of commissions paid to insurance broker	USD $3,995
Total amount of fees paid to insurance company	USD $845
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $26,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,995
Amount paid for insurance broker fees	845
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AZXM

Policy instance

Insurance contract or identification number	GLTD0AZXM
Number of Individuals Covered	133
Insurance policy start date	2019-05-01
Insurance policy end date	2020-05-01
Total amount of commissions paid to insurance broker	USD $2,427
Total amount of fees paid to insurance company	USD $499
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,427
Amount paid for insurance broker fees	499
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AZXM

Policy instance

Insurance contract or identification number	GVTL0AZXM
Number of Individuals Covered	45
Insurance policy start date	2019-05-01
Insurance policy end date	2020-05-01
Total amount of commissions paid to insurance broker	USD $2,057
Total amount of fees paid to insurance company	USD $404
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $13,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,057
Amount paid for insurance broker fees	404
Additional information about fees paid to insurance broker	AGENT OR BROKER RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0AZXM

Policy instance

Insurance contract or identification number	GUDH0AZXM
Number of Individuals Covered	15
Insurance policy start date	2019-05-01
Insurance policy end date	2020-05-01
Total amount of commissions paid to insurance broker	USD $684
Total amount of fees paid to insurance company	USD $138
Other welfare benefits provided	ACCIDENT VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $4,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $684
Amount paid for insurance broker fees	138
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0AZXM

Policy instance

Insurance contract or identification number	GUDE0AZXM
Number of Individuals Covered	18
Insurance policy start date	2019-05-01
Insurance policy end date	2020-05-01
Total amount of commissions paid to insurance broker	USD $518
Total amount of fees paid to insurance company	USD $100
Other welfare benefits provided	CI VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $3,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $518
Amount paid for insurance broker fees	100
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0AZXM

Policy instance

Insurance contract or identification number	GUDE0AZXM
Number of Individuals Covered	20
Insurance policy start date	2018-05-01
Insurance policy end date	2019-05-01
Total amount of commissions paid to insurance broker	USD $537
Other welfare benefits provided	CI VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $3,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $537
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0AZXM

Policy instance

Insurance contract or identification number	GUDH0AZXM
Number of Individuals Covered	16
Insurance policy start date	2018-05-01
Insurance policy end date	2019-05-01
Total amount of commissions paid to insurance broker	USD $782
Other welfare benefits provided	ACCIDENT VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $5,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $782
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AZXM

Policy instance

Insurance contract or identification number	GVTL0AZXM
Number of Individuals Covered	45
Insurance policy start date	2018-05-01
Insurance policy end date	2019-05-01
Total amount of commissions paid to insurance broker	USD $2,038
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $13,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,038
Additional information about fees paid to insurance broker	AGENT OR BROKER RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AZXM

Policy instance

Insurance contract or identification number	GLTD0AZXM
Number of Individuals Covered	144
Insurance policy start date	2018-05-01
Insurance policy end date	2019-05-01
Total amount of commissions paid to insurance broker	USD $2,544
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,544
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0AZXM

Policy instance

Insurance contract or identification number	GUG 0AZXM
Number of Individuals Covered	137
Insurance policy start date	2018-05-01
Insurance policy end date	2019-05-01
Total amount of commissions paid to insurance broker	USD $4,558
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $30,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,558
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AZXM

Policy instance

Insurance contract or identification number	GLUG0AZXM
Number of Individuals Covered	144
Insurance policy start date	2018-05-01
Insurance policy end date	2019-05-01
Total amount of commissions paid to insurance broker	USD $6,296
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $41,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,296
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0AZXM

Policy instance

Insurance contract or identification number	GUDE0AZXM
Number of Individuals Covered	31
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $552
Total amount of fees paid to insurance company	USD $100
Other welfare benefits provided	CI VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $3,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $552
Amount paid for insurance broker fees	100
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0AZXM

Policy instance

Insurance contract or identification number	GUDH0AZXM
Number of Individuals Covered	22
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $947
Total amount of fees paid to insurance company	USD $143
Other welfare benefits provided	ACCIDENT VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $6,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $947
Amount paid for insurance broker fees	143
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AZXM

Policy instance

Insurance contract or identification number	GVTL0AZXM
Number of Individuals Covered	43
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $1,813
Total amount of fees paid to insurance company	USD $278
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D - VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $12,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,813
Amount paid for insurance broker fees	278
Additional information about fees paid to insurance broker	AGENT OR BROKER RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AZXM

Policy instance

Insurance contract or identification number	GLTD0AZXM
Number of Individuals Covered	145
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $2,305
Total amount of fees paid to insurance company	USD $331
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,305
Amount paid for insurance broker fees	331
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0AZXM

Policy instance

Insurance contract or identification number	GUG 0AZXM
Number of Individuals Covered	145
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $3,103
Total amount of fees paid to insurance company	USD $445
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $20,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,103
Amount paid for insurance broker fees	445
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AZXM

Policy instance

Insurance contract or identification number	GLUG0AZXM
Number of Individuals Covered	145
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $4,869
Total amount of fees paid to insurance company	USD $699
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,869
Amount paid for insurance broker fees	699
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AZXM

Policy instance

Insurance contract or identification number	GLUG0AZXM
Number of Individuals Covered	128
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $4,634
Total amount of fees paid to insurance company	USD $487
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $30,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,634
Amount paid for insurance broker fees	487
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ALABAMA INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0AZXM

Policy instance

Insurance contract or identification number	GUG 0AZXM
Number of Individuals Covered	128
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $2,922
Total amount of fees paid to insurance company	USD $309
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $19,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,922
Amount paid for insurance broker fees	309
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ALABAMA INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0AZXM

Policy instance

Insurance contract or identification number	GLTD0AZXM
Number of Individuals Covered	128
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $2,178
Total amount of fees paid to insurance company	USD $229
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,178
Amount paid for insurance broker fees	229
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ALABAMA INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AZXM

Policy instance

Insurance contract or identification number	GVTL0AZXM
Number of Individuals Covered	46
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $2,011
Total amount of fees paid to insurance company	USD $222
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D & VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $13,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,011
Amount paid for insurance broker fees	222
Additional information about fees paid to insurance broker	AGENT OR BROKER RECORD OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ALABAMA INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDH0AZXM

Policy instance

Insurance contract or identification number	GUDH0AZXM
Number of Individuals Covered	22
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $1,056
Total amount of fees paid to insurance company	USD $124
Other welfare benefits provided	SHORT TERM DISABILITY VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $7,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,056
Amount paid for insurance broker fees	124
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ALABAMA INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUDE0AZXM

Policy instance

Insurance contract or identification number	GUDE0AZXM
Number of Individuals Covered	41
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $871
Total amount of fees paid to insurance company	USD $80
Other welfare benefits provided	CI VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $5,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $871
Amount paid for insurance broker fees	80
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS OF ALABAMA INC

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

Policy contract number

000010023240

Policy instance

Insurance contract or identification number	000010023240
Number of Individuals Covered	131
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $8,927
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,927
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SVCS PA

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

Policy contract number

000010023239

Policy instance

Insurance contract or identification number	000010023239
Number of Individuals Covered	131
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $3,468
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $69,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,468
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SVCS PA

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

Policy contract number

000010023240

Policy instance

Insurance contract or identification number	000010023240
Number of Individuals Covered	129
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $8,474
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,474
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SVCS PA

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

Policy contract number

000010023239

Policy instance

Insurance contract or identification number	000010023239
Number of Individuals Covered	129
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $3,283
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $65,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,283
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SVCS PA

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

Policy contract number

000010023240

Policy instance

Insurance contract or identification number	000010023240
Number of Individuals Covered	138
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $7,681
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,681
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SVCS PA

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

Policy contract number

000010023239

Policy instance

Insurance contract or identification number	000010023239
Number of Individuals Covered	140
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $2,964
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $59,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,964
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SVCS PA

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

Policy contract number

000010023239

Policy instance

Insurance contract or identification number	000010023239
Number of Individuals Covered	143
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $3,017
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $60,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,017
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SVCS PA

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

Policy contract number

000010023240

Policy instance

Insurance contract or identification number	000010023240
Number of Individuals Covered	143
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $7,849
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,849
Insurance broker organization code?	3
Insurance broker name	LOCKARD & WILLIAMS INS SCVS PA

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

Policy contract number

000010023239

Policy instance

Insurance contract or identification number	000010023239
Number of Individuals Covered	126
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,655
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $53,100
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

000010023240

Policy instance

Insurance contract or identification number	000010023240
Number of Individuals Covered	126
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,066
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,263
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

000010023240

Policy instance

Insurance contract or identification number	000010023240
Number of Individuals Covered	121
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,994
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,976
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

000010023239

Policy instance

Insurance contract or identification number	000010023239
Number of Individuals Covered	122
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,437
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $48,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MERCHANTS & MARINE BANK
Employer identification number (EIN):	646016232
NAIC Classification:	522110
NAIC Description:	Commercial Banking