401k Plan data: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN plan

PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 401k Plan overview

Plan Name	PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN
Plan identification number	504

PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE 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

401k Sponsoring company profile

PARK AEROSPACE CORP. has sponsored the creation of one or more 401k plans.

Company Name: PARK AEROSPACE CORP.

Employer identification number (EIN): 111734643

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2017-02-27 JAMES GUARINO JAMES GUARINO 2018-12-17
504 2016-03-01 MATTHEW FARABAUGH MATTHEW FARABAUGH 2017-07-25
504 2015-03-01 P. MATTHEW FARABAUGH P. MATTHEW FARABAUGH 2016-08-26
504 2015-01-01
504 2014-01-01
504 2013-01-01
504 2012-01-01 P. MATTHEW FARABAUGH
504 2011-01-01 P. MATTHEW FARABAUGH
504 2010-01-01 P. MATTHEW FARABAUGH
504 2009-01-01 P. MATTHEW FARABAUGH

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2017-02-27	JAMES GUARINO	JAMES GUARINO	2018-12-17
504	2016-03-01	MATTHEW FARABAUGH	MATTHEW FARABAUGH	2017-07-25
504	2015-03-01	P. MATTHEW FARABAUGH	P. MATTHEW FARABAUGH	2016-08-26
504	2015-01-01
504	2014-01-01
504	2013-01-01
504	2012-01-01	P. MATTHEW FARABAUGH
504	2011-01-01	P. MATTHEW FARABAUGH
504	2010-01-01	P. MATTHEW FARABAUGH
504	2009-01-01	P. MATTHEW FARABAUGH

Plan Statistics for PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN

401k plan membership statisitcs for PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN

Measure Date Value
2017: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-02-27 535
Total number of active participants reported on line 7a of the Form 5500 2017-02-27 185
Number of retired or separated participants receiving benefits 2017-02-27 12
Total of all active and inactive participants 2017-02-27 197
Total participants 2017-02-27 197
2016: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-03-01 579
Total number of active participants reported on line 7a of the Form 5500 2016-03-01 531
Number of retired or separated participants receiving benefits 2016-03-01 4
Total of all active and inactive participants 2016-03-01 535
Total participants 2016-03-01 535
2015: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-01 639
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 560
Number of retired or separated participants receiving benefits 2015-03-01 19
Total of all active and inactive participants 2015-03-01 579
Total participants, beginning-of-year 2015-01-01 621
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 633
Number of retired or separated participants receiving benefits 2015-01-01 6
Total of all active and inactive participants 2015-01-01 639
2014: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 757
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 616
Number of retired or separated participants receiving benefits 2014-01-01 5
Total of all active and inactive participants 2014-01-01 621
2013: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 878
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 731
Number of retired or separated participants receiving benefits 2013-01-01 26
Total of all active and inactive participants 2013-01-01 757
2012: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 932
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 847
Number of retired or separated participants receiving benefits 2012-01-01 31
Total of all active and inactive participants 2012-01-01 878
2011: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 951
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 918
Number of retired or separated participants receiving benefits 2011-01-01 14
Total of all active and inactive participants 2011-01-01 932
2010: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 910
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 918
Number of retired or separated participants receiving benefits 2010-01-01 33
Total of all active and inactive participants 2010-01-01 951
2009: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,080
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 860
Number of retired or separated participants receiving benefits 2009-01-01 50
Total of all active and inactive participants 2009-01-01 910

Measure	Date	Value
2017: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-02-27	535
Total number of active participants reported on line 7a of the Form 5500	2017-02-27	185
Number of retired or separated participants receiving benefits	2017-02-27	12
Total of all active and inactive participants	2017-02-27	197
Total participants	2017-02-27	197
2016: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-03-01	579
Total number of active participants reported on line 7a of the Form 5500	2016-03-01	531
Number of retired or separated participants receiving benefits	2016-03-01	4
Total of all active and inactive participants	2016-03-01	535
Total participants	2016-03-01	535
2015: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-01	639
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	560
Number of retired or separated participants receiving benefits	2015-03-01	19
Total of all active and inactive participants	2015-03-01	579
Total participants, beginning-of-year	2015-01-01	621
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	633
Number of retired or separated participants receiving benefits	2015-01-01	6
Total of all active and inactive participants	2015-01-01	639
2014: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	757
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	616
Number of retired or separated participants receiving benefits	2014-01-01	5
Total of all active and inactive participants	2014-01-01	621
2013: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	878
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	731
Number of retired or separated participants receiving benefits	2013-01-01	26
Total of all active and inactive participants	2013-01-01	757
2012: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	932
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	847
Number of retired or separated participants receiving benefits	2012-01-01	31
Total of all active and inactive participants	2012-01-01	878
2011: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	951
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	918
Number of retired or separated participants receiving benefits	2011-01-01	14
Total of all active and inactive participants	2011-01-01	932
2010: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	910
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	918
Number of retired or separated participants receiving benefits	2010-01-01	33
Total of all active and inactive participants	2010-01-01	951
2009: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,080
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	860
Number of retired or separated participants receiving benefits	2009-01-01	50
Total of all active and inactive participants	2009-01-01	910

Form 5500 Responses for PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN

2017: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2017 form 5500 responses
2017-02-27	Type of plan entity	Single employer plan
2017-02-27	Submission has been amended	No
2017-02-27	This submission is the final filing	No
2017-02-27	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-02-27	Plan is a collectively bargained plan	No
2017-02-27	Plan funding arrangement – Insurance	Yes
2017-02-27	Plan benefit arrangement – Insurance	Yes
2016: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2016 form 5500 responses
2016-03-01	Type of plan entity	Single employer plan
2016-03-01	Submission has been amended	No
2016-03-01	This submission is the final filing	No
2016-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-03-01	Plan is a collectively bargained plan	No
2016-03-01	Plan funding arrangement – Insurance	Yes
2016-03-01	Plan benefit arrangement – Insurance	Yes
2015: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2015 form 5500 responses
2015-03-01	Type of plan entity	Single employer plan
2015-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: PARK ELECTROCHEMICAL CORP EMPLOYEE HEALTH & LIFE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0869850-0287450

Policy instance

Insurance contract or identification number	0869850-0287450
Number of Individuals Covered	184
Insurance policy start date	2017-02-27
Insurance policy end date	2018-02-25
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ADD, SHORT TERM DISABILITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,887
Insurance broker name	PROFESSIONAL GROUP PLANS

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00618565

Policy instance

Insurance contract or identification number	00618565
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	MEDICAL AND VISION
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Amount paid for insurance broker fees	36111
Commission paid to Insurance Broker	USD $51,872
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	253
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $2,015
Total amount of fees paid to insurance company	USD $1,606
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,015
Amount paid for insurance broker fees	1606
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	253
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $269
Total amount of fees paid to insurance company	USD $214
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	253
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $3,264
Total amount of fees paid to insurance company	USD $2,033
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,737
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	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	89
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $209
Total amount of fees paid to insurance company	USD $197
Other welfare benefits provided	AD&D - VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $2,094
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	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	123
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $960
Total amount of fees paid to insurance company	USD $814
Other welfare benefits provided	STD
Welfare Benefit Premiums Paid to Carrier	USD $9,597
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	PROFESSIONAL GROUP PLANS INC

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	105
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $5,883
Total amount of fees paid to insurance company	USD $4,763
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $58,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,883
Amount paid for insurance broker fees	4763
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

592097

Policy instance

Insurance contract or identification number	592097
Number of Individuals Covered	92
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EAP-CAL. EMP. ASST. PROG.
Welfare Benefit Premiums Paid to Carrier	USD $1,371
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	0
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0869850

Policy instance

Insurance contract or identification number	0869850
Number of Individuals Covered	560
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-28
Total amount of commissions paid to insurance broker	USD $49,299
Total amount of fees paid to insurance company	USD $20,094
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,383,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,299
Amount paid for insurance broker fees	20094
Insurance broker name	GALLAGHER BENEFIT SERVICES INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	111
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $40
Total amount of fees paid to insurance company	USD $20
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D - SUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40
Amount paid for insurance broker fees	20
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

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

Policy contract number

0113326

Policy instance

Insurance contract or identification number	0113326
Number of Individuals Covered	572
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,747
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

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	257
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $356
Total amount of fees paid to insurance company	USD $178
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
Welfare Benefit Premiums Paid to Carrier	USD $3,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $356
Amount paid for insurance broker fees	178
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	115
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $965
Total amount of fees paid to insurance company	USD $482
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $9,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $965
Amount paid for insurance broker fees	482
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	257
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $678
Total amount of fees paid to insurance company	USD $226
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $678
Amount paid for insurance broker fees	226
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	126
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $165
Total amount of fees paid to insurance company	USD $82
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $1,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $165
Amount paid for insurance broker fees	82
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	257
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $47
Total amount of fees paid to insurance company	USD $24
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47
Amount paid for insurance broker fees	24
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	639
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $348
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	0
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	633
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $5,944
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $193,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,944
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	257
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $300
Total amount of fees paid to insurance company	USD $150
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $300
Amount paid for insurance broker fees	150
Insurance broker name	PROFESSIONAL GROUP PLANS INC

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	611
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $81,037
Total amount of fees paid to insurance company	USD $28,400
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,806,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,037
Amount paid for insurance broker fees	28400
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

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

Policy contract number

0113326

Policy instance

Insurance contract or identification number	0113326
Number of Individuals Covered	554
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 $138
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $230,337
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	138
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICE INC

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	257
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,250
Total amount of fees paid to insurance company	USD $1,125
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
Welfare Benefit Premiums Paid to Carrier	USD $22,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,250
Amount paid for insurance broker fees	1125
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	630
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
Welfare Benefit Premiums Paid to Carrier	USD $5,106
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	0
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	257
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,429
Total amount of fees paid to insurance company	USD $1,429
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,429
Amount paid for insurance broker fees	1429
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	111
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $272
Total amount of fees paid to insurance company	USD $136
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $2,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $272
Amount paid for insurance broker fees	136
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	127
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,074
Total amount of fees paid to insurance company	USD $537
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	STD
Welfare Benefit Premiums Paid to Carrier	USD $10,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,074
Amount paid for insurance broker fees	537
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 )

Policy contract number

G000ARKD

Policy instance

Insurance contract or identification number	G000ARKD
Number of Individuals Covered	147
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,461
Total amount of fees paid to insurance company	USD $3,231
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $64,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,461
Amount paid for insurance broker fees	3231
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL GROUP PLANS INC

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	5
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $208
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $39,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $208
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

810864

Policy instance

Insurance contract or identification number	810864
Number of Individuals Covered	455
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $11,339
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
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD
Welfare Benefit Premiums Paid to Carrier	USD $123,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,339
Insurance broker organization code?	3
Insurance broker name	BENEFITS PLUS FINANCIAL SERVICES, I

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	740
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKERAGE FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	6
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $224
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $49,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $224
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKERAGE FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

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

Policy contract number

0113326

Policy instance

Insurance contract or identification number	0113326
Number of Individuals Covered	701
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $574
Total amount of fees paid to insurance company	USD $401
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $244,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $574
Amount paid for insurance broker fees	401
Additional information about fees paid to insurance broker	BROKERAGE FEES
Insurance broker organization code?	3
Insurance broker name

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

720813

Policy instance

Insurance contract or identification number	720813
Number of Individuals Covered	725
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $126,484
Total amount of fees paid to insurance company	USD $24,400
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,181,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $126,484
Amount paid for insurance broker fees	24400
Additional information about fees paid to insurance broker	BROKERAGE FEES
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

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

Policy contract number

0113326

Policy instance

Insurance contract or identification number	0113326
Number of Individuals Covered	792
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,670
Total amount of fees paid to insurance company	USD $5,358
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $301,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,670
Amount paid for insurance broker fees	5358
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION - 4,610NON-MONETARY COMPENSATION - 33SUPLEM
Insurance broker organization code?	3
Insurance broker name

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

1595404

Policy instance

Insurance contract or identification number	1595404
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $559
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
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	NEW YORK DISABILITY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $2,235
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	BENEFITS PLUS FINANCIAL SERVICES

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

Policy contract number

700852

Policy instance

Insurance contract or identification number	700852
Number of Individuals Covered	847
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $86,855
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,440,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $86,855
Insurance broker organization code?	3
Insurance broker name	WILLIS OF NEW YORK INC.

SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 80926 )

Policy contract number

810864

Policy instance

Insurance contract or identification number	810864
Number of Individuals Covered	561
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,623
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
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STD
Welfare Benefit Premiums Paid to Carrier	USD $138,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,623
Insurance broker organization code?	3
Insurance broker name	BENEFITS PLUS FINANCIAL SERVICES

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

Policy contract number

700852

Policy instance

Insurance contract or identification number	700852
Number of Individuals Covered	918
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $86,148
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,784,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	107
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	367
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,694
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	391
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	BASIC AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	391
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $10,240
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
Welfare Benefit Premiums Paid to Carrier	USD $7,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	173
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $3,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

1595404

Policy instance

Insurance contract or identification number	1595404
Number of Individuals Covered	62
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $650
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	175
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	175
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $10,240
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
Welfare Benefit Premiums Paid to Carrier	USD $75,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0113326

Policy instance

Insurance contract or identification number	0113326
Number of Individuals Covered	871
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,465
Total amount of fees paid to insurance company	USD $5,171
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

1595404

Policy instance

Insurance contract or identification number	1595404
Number of Individuals Covered	76
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $360
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
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	170
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

42005

Policy instance

Insurance contract or identification number	42005
Number of Individuals Covered	382
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,088
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
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0113326

Policy instance

Insurance contract or identification number	0113326
Number of Individuals Covered	855
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,629
Total amount of fees paid to insurance company	USD $4,454
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $278,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

700852

Policy instance

Insurance contract or identification number	700852
Number of Individuals Covered	918
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $89,132
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,581,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	PARK AEROSPACE CORP.
Employer identification number (EIN):	111734643
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies