401k Plan data: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN plan

GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 401k Plan overview

Plan Name	GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN
Plan identification number	501

GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

ERNIE PALMER INC. has sponsored the creation of one or more 401k plans.

Company Name: ERNIE PALMER INC.

Employer identification number (EIN): 650452841

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01 EDWARD ANDERSON 2024-01-15 EDWARD ANDERSON 2024-01-15
501 2021-04-01 EDWARD ANDERSON 2023-01-16 EDWARD ANDERSON 2023-01-16
501 2020-04-01 EDWARD ANDERSON 2022-01-17 EDWARD ANDERSON 2022-01-17
501 2019-04-01 LESLIE FREITAS 2021-01-15 LESLIE FREITAS 2021-01-15
501 2018-04-01 LESLIE FREITAS 2020-01-15
501 2017-04-01
501 2016-04-01
501 2015-04-01
501 2014-04-01
501 2013-04-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-04-01	EDWARD ANDERSON	2024-01-15	EDWARD ANDERSON	2024-01-15
501	2021-04-01	EDWARD ANDERSON	2023-01-16	EDWARD ANDERSON	2023-01-16
501	2020-04-01	EDWARD ANDERSON	2022-01-17	EDWARD ANDERSON	2022-01-17
501	2019-04-01	LESLIE FREITAS	2021-01-15	LESLIE FREITAS	2021-01-15
501	2018-04-01	LESLIE FREITAS	2020-01-15
501	2017-04-01
501	2016-04-01
501	2015-04-01
501	2014-04-01
501	2013-04-01

Plan Statistics for GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN

401k plan membership statisitcs for GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN

Measure Date Value
2022: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 180
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 176
Total of all active and inactive participants 2022-04-01 176
2021: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-04-01 224
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 180
Total of all active and inactive participants 2021-04-01 180
2020: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 214
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 224
Total of all active and inactive participants 2020-04-01 224
2019: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-04-01 189
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 214
Total of all active and inactive participants 2019-04-01 214
2018: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-04-01 231
Total number of active participants reported on line 7a of the Form 5500 2018-04-01 189
Total of all active and inactive participants 2018-04-01 189
2017: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 126
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 231
Total of all active and inactive participants 2017-04-01 231
2016: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 131
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 126
Total of all active and inactive participants 2016-04-01 126
2015: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-01 146
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 131
Total of all active and inactive participants 2015-04-01 131
2014: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-04-01 159
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 146
Number of retired or separated participants receiving benefits 2014-04-01 0
Total of all active and inactive participants 2014-04-01 146
2013: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-04-01 159
Total number of active participants reported on line 7a of the Form 5500 2013-04-01 159
Total of all active and inactive participants 2013-04-01 159

Measure	Date	Value
2022: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	180
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	176
Total of all active and inactive participants	2022-04-01	176
2021: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-04-01	224
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	180
Total of all active and inactive participants	2021-04-01	180
2020: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	214
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	224
Total of all active and inactive participants	2020-04-01	224
2019: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-04-01	189
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	214
Total of all active and inactive participants	2019-04-01	214
2018: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-04-01	231
Total number of active participants reported on line 7a of the Form 5500	2018-04-01	189
Total of all active and inactive participants	2018-04-01	189
2017: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	126
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	231
Total of all active and inactive participants	2017-04-01	231
2016: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	131
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	126
Total of all active and inactive participants	2016-04-01	126
2015: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-01	146
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	131
Total of all active and inactive participants	2015-04-01	131
2014: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-04-01	159
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	146
Number of retired or separated participants receiving benefits	2014-04-01	0
Total of all active and inactive participants	2014-04-01	146
2013: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-04-01	159
Total number of active participants reported on line 7a of the Form 5500	2013-04-01	159
Total of all active and inactive participants	2013-04-01	159

Form 5500 Responses for GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN

2022: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2021: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2018: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2017: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2014: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes
2013: GULF COAST MOTOR SALES, INC. FLEXIBLE BENEFIT PLAN 2013 form 5500 responses
2013-04-01	Type of plan entity	Single employer plan
2013-04-01	Submission has been amended	Yes
2013-04-01	Plan funding arrangement – Insurance	Yes
2013-04-01	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

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	17
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $1,719
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 $11,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,719
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10000221001

Policy instance

Insurance contract or identification number	10000221001
Number of Individuals Covered	272
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,064
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,064
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	262
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIRMED
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

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	183
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $2,040
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 $13,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,040
Insurance broker organization code?	3

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Insurance broker organization code?	3

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	109
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $19,215
Total amount of fees paid to insurance company	USD $1,840
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $214,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,431
Insurance broker organization code?	3
Amount paid for insurance broker fees	1840
Additional information about fees paid to insurance broker	BROKER BONUS

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	91
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $15,565
Total amount of fees paid to insurance company	USD $1,961
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $200,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,809
Insurance broker organization code?	3
Amount paid for insurance broker fees	1961
Additional information about fees paid to insurance broker	BROKER BONUS

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	59
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $6,317
Total amount of fees paid to insurance company	USD $1,019
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $95,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,801
Insurance broker organization code?	3
Amount paid for insurance broker fees	1019
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	189
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $2,100
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 $13,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,100
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	258
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIRMED
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

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	20
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $1,752
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 $11,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,752
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10000221001

Policy instance

Insurance contract or identification number	10000221001
Number of Individuals Covered	259
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,508
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,508
Insurance broker organization code?	3

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	85
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $14,791
Total amount of fees paid to insurance company	USD $1,854
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $188,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,213
Insurance broker organization code?	3
Amount paid for insurance broker fees	1854
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	26
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $3,025
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 $20,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,025
Insurance broker organization code?	3

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	61
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $7,816
Total amount of fees paid to insurance company	USD $1,065
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $97,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,864
Insurance broker organization code?	3
Amount paid for insurance broker fees	1065
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	191
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $2,153
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 $14,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,153
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	276
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	BABY YOURSELF, AIRMED
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10000221001

Policy instance

Insurance contract or identification number	10000221001
Number of Individuals Covered	258
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,199
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,199
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10000221001

Policy instance

Insurance contract or identification number	10000221001
Number of Individuals Covered	235
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,777
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,777
Insurance broker organization code?	3

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

Policy contract number

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	197
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $2,134
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 $14,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,134
Insurance broker organization code?	3

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	36
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $9,192
Total amount of fees paid to insurance company	USD $765
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $73,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,512
Insurance broker organization code?	3
Amount paid for insurance broker fees	765
Additional information about fees paid to insurance broker	BROKER BONUS

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	82
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $19,960
Total amount of fees paid to insurance company	USD $1,769
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $182,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,234
Insurance broker organization code?	3
Amount paid for insurance broker fees	1769
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	30
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $3,284
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 $21,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,284
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	151
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EPS, BABY YOURSELF, AIRMED
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

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	185
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $2,085
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 $13,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,085
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10000221001

Policy instance

Insurance contract or identification number	10000221001
Number of Individuals Covered	228
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,743
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,743
Insurance broker organization code?	3

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	85
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $12,145
Total amount of fees paid to insurance company	USD $1,787
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $187,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,979
Insurance broker organization code?	3
Amount paid for insurance broker fees	1787
Additional information about fees paid to insurance broker	BROKER BONUS

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

Policy contract number

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	34
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $3,409
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 $22,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,409
Insurance broker organization code?	3

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	50
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $6,397
Total amount of fees paid to insurance company	USD $671
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $62,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,279
Insurance broker organization code?	3
Amount paid for insurance broker fees	671
Additional information about fees paid to insurance broker	BROKER BONUS

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	143
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EPS, BABY YOURSELF, AIRMED
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10000221001

Policy instance

Insurance contract or identification number	10000221001
Number of Individuals Covered	230
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $2,688
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,688
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GENERAL AGENCY

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	148
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EPS, BABY YOURSELF, AIRMED
Welfare Benefit Premiums Paid to Carrier	USD $8,532
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

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	197
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $1,707
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 $11,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,707
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GEN AGCY

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	59
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $7,096
Total amount of fees paid to insurance company	USD $582
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $52,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,459
Insurance broker organization code?	3
Amount paid for insurance broker fees	582
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	AUTOMOBILE DEALERS ASSOC OF ALABAMA

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	98
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $21,860
Total amount of fees paid to insurance company	USD $1,686
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $171,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,917
Insurance broker organization code?	3
Amount paid for insurance broker fees	1686
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	AUTOMOBILE DEALERS ASSOC OF ALABAMA

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	88
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $10,416
Total amount of fees paid to insurance company	USD $1,392
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, AD&D
Welfare Benefit Premiums Paid to Carrier	USD $134,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,299
Insurance broker organization code?	3
Amount paid for insurance broker fees	1392
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	O&A INS SERVICES INC

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	33
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $6,520
Total amount of fees paid to insurance company	USD $472
Health Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $36,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,709
Insurance broker organization code?	3
Amount paid for insurance broker fees	472
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	AUTOMOBILE DEALERS ASSOC OF ALABAMA

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

Policy contract number

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	44
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $3,303
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 $22,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,303
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GEN AGCY

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

Policy contract number

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	178
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $1,504
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,504
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GEN AGCY

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	129
Insurance policy start date	2014-12-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EPS, BABY YOURSELF, AIRMED
Welfare Benefit Premiums Paid to Carrier	USD $8,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10000221001

Policy instance

Insurance contract or identification number	10000221001
Number of Individuals Covered	187
Insurance policy start date	2015-04-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $1,156
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,156
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GENERAL AGNCY INC

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	69
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $11,797
Total amount of fees paid to insurance company	USD $1,128
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, AD&D, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $106,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,519
Insurance broker organization code?	3
Amount paid for insurance broker fees	1128
Additional information about fees paid to insurance broker	BROKER BONUS/COMMISSIONS
Insurance broker name	O&A INS SERVICES INC

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	26
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $1,320
Total amount of fees paid to insurance company	USD $399
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $35,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,784
Insurance broker organization code?	3
Amount paid for insurance broker fees	399
Additional information about fees paid to insurance broker	BROKER BONUS/COMMISSIONS
Insurance broker name	AMERICAN FIDELITY ASSURANCE COMPANY

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

Policy contract number

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	45
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $4,365
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $29,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,365
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GEN AGCY

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

Policy contract number

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	158
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $1,719
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,719
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GEN AGCY

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

523204/523415

Policy instance

Insurance contract or identification number	523204/523415
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	O&A INS SERVICES INC

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	116
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EPS, BABY YOURSELF, AIRMED
Welfare Benefit Premiums Paid to Carrier	USD $8,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

67950

Policy instance

Insurance contract or identification number	67950
Number of Individuals Covered	59
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $-58
Total amount of fees paid to insurance company	USD $1,136
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $96,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1136
Additional information about fees paid to insurance broker	BROKER BONUS/COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY ASSURANCE COMPANY

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

523204/523415

Policy instance

Insurance contract or identification number	523204/523415
Number of Individuals Covered	112
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $119
Total amount of fees paid to insurance company	USD $115
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $119
Amount paid for insurance broker fees	115
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	O&A INS SERVICES INC

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

36830

Policy instance

Insurance contract or identification number	36830
Number of Individuals Covered	104
Insurance policy start date	2012-12-01
Insurance policy end date	2013-11-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	EPS, BABY YOURSELF, AIRMED
Welfare Benefit Premiums Paid to Carrier	USD $7,952
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

000010158104

Policy instance

Insurance contract or identification number	000010158104
Number of Individuals Covered	159
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $1,141
Total amount of fees paid to insurance company	USD $225
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $7,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,141
Amount paid for insurance broker fees	225
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GEN AGCY

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

Policy contract number

000400158105

Policy instance

Insurance contract or identification number	000400158105
Number of Individuals Covered	62
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,089
Total amount of fees paid to insurance company	USD $1,127
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $33,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,089
Amount paid for insurance broker fees	1127
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	AMERICAN FIDELITY GEN AGCY

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

93122

Policy instance

Insurance contract or identification number	93122
Number of Individuals Covered	20
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $2,821
Total amount of fees paid to insurance company	USD $347
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $27,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,466
Insurance broker organization code?	3
Amount paid for insurance broker fees	347
Additional information about fees paid to insurance broker	BROKER BONUS/COMMISSIONS
Insurance broker name	AUTOMOBILE DEALERS ASSOC OF ALABAMA

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Company Name:	ERNIE PALMER INC.
Employer identification number (EIN):	650452841
NAIC Classification:	441110
NAIC Description:	New Car Dealers