401k Plan data: MASTERS SCHOOL, INC.

MASTERS SCHOOL, INC. - CAFETERIA PLAN 401k Plan overview

Plan Name	MASTERS SCHOOL, INC. - CAFETERIA PLAN
Plan identification number	501

MASTERS SCHOOL, INC. - CAFETERIA 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

THE MASTERS SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: THE MASTERS SCHOOL

Employer identification number (EIN): 131740472

NAIC Classification: 611000

Additional information about THE MASTERS SCHOOL

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C3093805

More information about THE MASTERS SCHOOL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MASTERS SCHOOL, INC. - CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 ANDREW SCHNEIDER 2023-10-16 ANDREW SCHNEIDER 2023-10-16
501 2021-01-01 ANDREW SCHNEIDER 2023-10-16 ANDREW SCHNEIDER 2023-10-16
501 2020-01-01 EDWARD E. BIDDLE 2021-10-12
501 2019-01-01 EDWARD E. BIDDLE 2020-10-13
501 2018-01-01 EDWARD E. BIDDLE 2019-10-15
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 BOB ROONEY
501 2011-01-01 CHRISTINE SCHWEGEL
501 2010-01-01 LEW WYMAN
501 2009-01-01 LEW WAYMAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	ANDREW SCHNEIDER	2023-10-16	ANDREW SCHNEIDER	2023-10-16
501	2021-01-01	ANDREW SCHNEIDER	2023-10-16	ANDREW SCHNEIDER	2023-10-16
501	2020-01-01	EDWARD E. BIDDLE	2021-10-12
501	2019-01-01	EDWARD E. BIDDLE	2020-10-13
501	2018-01-01	EDWARD E. BIDDLE	2019-10-15
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	BOB ROONEY
501	2011-01-01	CHRISTINE SCHWEGEL
501	2010-01-01	LEW WYMAN
501	2009-01-01	LEW WAYMAN

Plan Statistics for MASTERS SCHOOL, INC. - CAFETERIA PLAN

401k plan membership statisitcs for MASTERS SCHOOL, INC. - CAFETERIA PLAN

Measure Date Value
2022: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 152
Total of all active and inactive participants 2022-01-01 152
2021: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 128
Total of all active and inactive participants 2021-01-01 128
2020: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 223
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 197
Total of all active and inactive participants 2020-01-01 197
2019: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 249
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 223
Total of all active and inactive participants 2019-01-01 223
2018: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 215
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 249
Total of all active and inactive participants 2018-01-01 249
2017: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 215
Total of all active and inactive participants 2017-01-01 215
2016: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 233
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 246
Total of all active and inactive participants 2016-01-01 246
2015: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 245
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 233
Total of all active and inactive participants 2015-01-01 233
2014: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 242
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 245
Total of all active and inactive participants 2014-01-01 245
2013: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 242
Total of all active and inactive participants 2013-01-01 242
2012: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 178
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 227
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 227
2011: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 178
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 178
Number of retired or separated participants receiving benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 178
2010: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 201
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 183
Number of retired or separated participants receiving benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 184
2009: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 200
Number of retired or separated participants receiving benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 201

Measure	Date	Value
2022: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	152
Total of all active and inactive participants	2022-01-01	152
2021: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	128
Total of all active and inactive participants	2021-01-01	128
2020: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	223
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	197
Total of all active and inactive participants	2020-01-01	197
2019: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	249
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	223
Total of all active and inactive participants	2019-01-01	223
2018: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	215
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	249
Total of all active and inactive participants	2018-01-01	249
2017: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	215
Total of all active and inactive participants	2017-01-01	215
2016: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	233
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	246
Total of all active and inactive participants	2016-01-01	246
2015: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	245
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	233
Total of all active and inactive participants	2015-01-01	233
2014: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	242
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	245
Total of all active and inactive participants	2014-01-01	245
2013: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	242
Total of all active and inactive participants	2013-01-01	242
2012: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	178
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	227
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	227
2011: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	178
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	178
Number of retired or separated participants receiving benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	178
2010: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	201
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	183
Number of retired or separated participants receiving benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	184
2009: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	200
Number of retired or separated participants receiving benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	201

Form 5500 Responses for MASTERS SCHOOL, INC. - CAFETERIA PLAN

2022: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MASTERS SCHOOL, INC. - CAFETERIA 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: MASTERS SCHOOL, INC. - CAFETERIA 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: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MASTERS SCHOOL, INC. - CAFETERIA PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: MASTERS SCHOOL, INC. - CAFETERIA 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 benefit arrangement – Insurance	Yes
2009: MASTERS SCHOOL, INC. - CAFETERIA 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00557641

Policy instance

Insurance contract or identification number	00557641
Number of Individuals Covered	154
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $5,994
Total amount of fees paid to insurance company	USD $5,634
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $174,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,994
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Amount paid for insurance broker fees	5634

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

Policy contract number

720590

Policy instance

Insurance contract or identification number	720590
Number of Individuals Covered	150
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $81,684
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,559,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,684
Additional information about fees paid to insurance broker	PURPOSE OF THESE FEES IS INCENTIVES, EDUCATION, COMMUNICATION AND TRA
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	41
Insurance policy start date	2022-07-01
Insurance policy end date	2023-07-01
Total amount of commissions paid to insurance broker	USD $151
Total amount of fees paid to insurance company	USD $22
Other welfare benefits provided	AD&D WITH LIFE
Welfare Benefit Premiums Paid to Carrier	USD $1,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $151
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	22

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	210
Insurance policy start date	2022-07-01
Insurance policy end date	2023-07-01
Total amount of commissions paid to insurance broker	USD $6,697
Total amount of fees paid to insurance company	USD $1,134
Other welfare benefits provided	SHORT-TERM DISABILITY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $44,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,697
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	1134

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	210
Insurance policy start date	2022-07-01
Insurance policy end date	2023-07-01
Total amount of commissions paid to insurance broker	USD $4,788
Total amount of fees paid to insurance company	USD $816
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,788
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	816

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	210
Insurance policy start date	2022-07-01
Insurance policy end date	2023-07-01
Total amount of commissions paid to insurance broker	USD $454
Total amount of fees paid to insurance company	USD $115
Other welfare benefits provided	AD&D WITH LIFE
Welfare Benefit Premiums Paid to Carrier	USD $4,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $454
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	115

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	50
Insurance policy start date	2022-07-01
Insurance policy end date	2023-07-01
Total amount of commissions paid to insurance broker	USD $2,209
Total amount of fees paid to insurance company	USD $380
Other welfare benefits provided	TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,209
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	380

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	210
Insurance policy start date	2022-07-01
Insurance policy end date	2023-07-01
Total amount of commissions paid to insurance broker	USD $2,872
Total amount of fees paid to insurance company	USD $701
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,872
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	701

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

Policy contract number

720590

Policy instance

Insurance contract or identification number	720590
Number of Individuals Covered	140
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $78,305
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,277,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $78,305
Additional information about fees paid to insurance broker	PURPOSE OF THESE FEES IS INCENTIVES, EDUCATION, COMMUNICATIONAND TRIN
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	202
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-01
Total amount of commissions paid to insurance broker	USD $407
Total amount of fees paid to insurance company	USD $327
Other welfare benefits provided	AD&D WITH LIFE
Welfare Benefit Premiums Paid to Carrier	USD $4,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $273
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	115

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	202
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-01
Total amount of commissions paid to insurance broker	USD $4,330
Total amount of fees paid to insurance company	USD $2,334
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,897
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	821

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	202
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-02
Total amount of commissions paid to insurance broker	USD $6,010
Total amount of fees paid to insurance company	USD $3,230
Other welfare benefits provided	SHORT-TERM DISABILITY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $40,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,027
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	1136

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	49
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-01
Total amount of commissions paid to insurance broker	USD $146
Total amount of fees paid to insurance company	USD $64
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $104
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	21

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	202
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-01
Total amount of commissions paid to insurance broker	USD $2,032
Total amount of fees paid to insurance company	USD $1,632
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,364
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	573

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	57
Insurance policy start date	2021-02-01
Insurance policy end date	2022-02-01
Total amount of commissions paid to insurance broker	USD $2,052
Total amount of fees paid to insurance company	USD $897
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,308
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3
Amount paid for insurance broker fees	423

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00557641

Policy instance

Insurance contract or identification number	00557641
Number of Individuals Covered	139
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $8,392
Total amount of fees paid to insurance company	USD $5,362
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $140,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,527
Amount paid for insurance broker fees	5362
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	120
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $1,190
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $713
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	120
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $1,185
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $793
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00557641

Policy instance

Insurance contract or identification number	00557641
Number of Individuals Covered	130
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $16,137
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,557
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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

Policy contract number

00618319

Policy instance

Insurance contract or identification number	00618319
Number of Individuals Covered	180
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $1,764
Total amount of fees paid to insurance company	USD $116,521
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,085,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,764
Amount paid for insurance broker fees	71486
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	120
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $3,875
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,544
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	56
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $1,848
Total amount of fees paid to insurance company	USD $1,338
Welfare Benefit Premiums Paid to Carrier	USD $13,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,848
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	197
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $1,776
Total amount of fees paid to insurance company	USD $2,766
Welfare Benefit Premiums Paid to Carrier	USD $19,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,776
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	44
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $108
Total amount of fees paid to insurance company	USD $109
Welfare Benefit Premiums Paid to Carrier	USD $788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	197
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $5,270
Total amount of fees paid to insurance company	USD $5,474
Welfare Benefit Premiums Paid to Carrier	USD $38,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,270
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	197
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $3,802
Total amount of fees paid to insurance company	USD $3,951
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,802
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

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

Policy contract number

G000BPL6

Policy instance

Insurance contract or identification number	G000BPL6
Number of Individuals Covered	197
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $355
Total amount of fees paid to insurance company	USD $554
Welfare Benefit Premiums Paid to Carrier	USD $3,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $355
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	213
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $5,631
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,051
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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

Policy contract number

00618319

Policy instance

Insurance contract or identification number	00618319
Number of Individuals Covered	184
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $901
Total amount of fees paid to insurance company	USD $102,424
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,146,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $901
Amount paid for insurance broker fees	58959
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00557641

Policy instance

Insurance contract or identification number	00557641
Number of Individuals Covered	132
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $12,067
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $132,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,621
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	213
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $6,584
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,949
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	223
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $5,726
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,750
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	209
Insurance policy start date	2018-07-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $4,240
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,982
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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

Policy contract number

00618319

Policy instance

Insurance contract or identification number	00618319
Number of Individuals Covered	183
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $61,063
Total amount of fees paid to insurance company	USD $40,709
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,058,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $61,063
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	231
Insurance policy start date	2018-07-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $3,774
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,172
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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

Policy contract number

0618319

Policy instance

Insurance contract or identification number	0618319
Number of Individuals Covered	131
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $8,998
Total amount of fees paid to insurance company	USD $4,385
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,998
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	249
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $6,255
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,798
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	216
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $6,299
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,920
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	205
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,808
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,366
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL PENSIONS INC

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

447024

Policy instance

Insurance contract or identification number	447024
Number of Individuals Covered	209
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,181
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,290
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL PENSIONS INC

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

Policy contract number

00618319

Policy instance

Insurance contract or identification number	00618319
Number of Individuals Covered	190
Insurance policy start date	2017-02-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $93,247
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,872,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,948
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL PENSIONS INC

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

Policy contract number

0618319

Policy instance

Insurance contract or identification number	0618319
Number of Individuals Covered	140
Insurance policy start date	2017-02-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,979
Total amount of fees paid to insurance company	USD $4,421
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,152
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
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SERVICE/GENERAL AGENT PAYMENTS
Insurance broker name	PROFESSIONAL PENSIONS INC

THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )

Policy contract number

754305

Policy instance

Insurance contract or identification number	754305
Number of Individuals Covered	215
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,659
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	STATE DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,882
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PROFESSIONAL PENSIONS INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000539504

Policy instance

Insurance contract or identification number	000000539504
Number of Individuals Covered	195
Insurance policy start date	2015-01-01
Insurance policy end date	2015-02-01
Total amount of commissions paid to insurance broker	USD $361
Total amount of fees paid to insurance company	USD $54
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $361
Amount paid for insurance broker fees	54
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000221362

Policy instance

Insurance contract or identification number	000000221362
Number of Individuals Covered	225
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $1,695
Total amount of fees paid to insurance company	USD $141
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,695
Amount paid for insurance broker fees	141
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

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

Policy contract number

0492254

Policy instance

Insurance contract or identification number	0492254
Number of Individuals Covered	245
Insurance policy start date	2015-01-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $4,554
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $145,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,554
Insurance broker organization code?	3
Insurance broker name	AUSTIN & COMPANY, INC.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00509797

Policy instance

Insurance contract or identification number	00509797
Number of Individuals Covered	201
Insurance policy start date	2015-02-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,922
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $115,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,922
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

MS33864

Policy instance

Insurance contract or identification number	MS33864
Number of Individuals Covered	233
Insurance policy start date	2015-02-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $48,167
Total amount of fees paid to insurance company	USD $4,000
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,604,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,167
Amount paid for insurance broker fees	4000
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

872201G

Policy instance

Insurance contract or identification number	872201G
Number of Individuals Covered	198
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,931
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,022
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,931
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000539504

Policy instance

Insurance contract or identification number	000000539504
Number of Individuals Covered	195
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $3,393
Total amount of fees paid to insurance company	USD $600
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 $48,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,393
Amount paid for insurance broker fees	600
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000221362

Policy instance

Insurance contract or identification number	000000221362
Number of Individuals Covered	215
Insurance policy start date	2014-01-01
Insurance policy end date	2015-01-01
Total amount of commissions paid to insurance broker	USD $1,649
Total amount of fees paid to insurance company	USD $137
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 $10,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,649
Amount paid for insurance broker fees	137
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

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

Policy contract number

0492254

Policy instance

Insurance contract or identification number	0492254
Number of Individuals Covered	245
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $54,725
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
Welfare Benefit Premiums Paid to Carrier	USD $1,760,842
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,725
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

872201G

Policy instance

Insurance contract or identification number	872201G
Number of Individuals Covered	196
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,314
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 $30,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,314
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

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

Policy contract number

0492254

Policy instance

Insurance contract or identification number	0492254
Number of Individuals Covered	242
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Total amount of commissions paid to insurance broker	USD $51,536
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
Welfare Benefit Premiums Paid to Carrier	USD $1,660,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,536
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

872201G

Policy instance

Insurance contract or identification number	872201G
Number of Individuals Covered	188
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,470
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 $25,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,470
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000539504

Policy instance

Insurance contract or identification number	000000539504
Number of Individuals Covered	189
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $3,202
Total amount of fees paid to insurance company	USD $549
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 $43,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,202
Amount paid for insurance broker fees	549
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000221362

Policy instance

Insurance contract or identification number	000000221362
Number of Individuals Covered	207
Insurance policy start date	2013-01-01
Insurance policy end date	2014-01-01
Total amount of commissions paid to insurance broker	USD $1,952
Total amount of fees paid to insurance company	USD $163
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 $10,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,952
Amount paid for insurance broker fees	163
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000221362

Policy instance

Insurance contract or identification number	000000221362
Number of Individuals Covered	192
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $1,098
Total amount of fees paid to insurance company	USD $91
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 $9,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,098
Amount paid for insurance broker fees	91
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

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

Policy contract number

60054

Policy instance

Insurance contract or identification number	60054
Number of Individuals Covered	227
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $53,891
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
Welfare Benefit Premiums Paid to Carrier	USD $1,332,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,891
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000539504

Policy instance

Insurance contract or identification number	000000539504
Number of Individuals Covered	157
Insurance policy start date	2012-01-01
Insurance policy end date	2013-01-01
Total amount of commissions paid to insurance broker	USD $3,500
Total amount of fees paid to insurance company	USD $543
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
Welfare Benefit Premiums Paid to Carrier	USD $43,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,500
Amount paid for insurance broker fees	543
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

872201G

Policy instance

Insurance contract or identification number	872201G
Number of Individuals Covered	172
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $3,356
Total amount of fees paid to insurance company	USD $649
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 $27,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,356
Amount paid for insurance broker fees	649
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

EBS-RMSCO, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

MAS472

Policy instance

Insurance contract or identification number	MAS472
Number of Individuals Covered	227
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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
Other welfare benefits provided	FSA
Welfare Benefit Premiums Paid to Carrier	USD $1,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000221362

Policy instance

Insurance contract or identification number	000000221362
Number of Individuals Covered	181
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $1,415
Total amount of fees paid to insurance company	USD $118
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 $9,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000539504

Policy instance

Insurance contract or identification number	000000539504
Number of Individuals Covered	168
Insurance policy start date	2011-01-01
Insurance policy end date	2012-01-01
Total amount of commissions paid to insurance broker	USD $6,583
Total amount of fees paid to insurance company	USD $895
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
Welfare Benefit Premiums Paid to Carrier	USD $71,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

492254

Policy instance

Insurance contract or identification number	492254
Number of Individuals Covered	200
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $47,920
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
Welfare Benefit Premiums Paid to Carrier	USD $1,109,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000221362

Policy instance

Insurance contract or identification number	000000221362
Number of Individuals Covered	172
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $1,361
Total amount of fees paid to insurance company	USD $113
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 $9,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,361
Amount paid for insurance broker fees	113
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

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

Policy contract number

492254

Policy instance

Insurance contract or identification number	492254
Number of Individuals Covered	184
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $47,559
Total amount of fees paid to insurance company	USD $480
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
Welfare Benefit Premiums Paid to Carrier	USD $1,175,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,559
Amount paid for insurance broker fees	480
Additional information about fees paid to insurance broker	PM CROSS-SALE
Insurance broker organization code?	3
Insurance broker name	AUSTIN & COMPANY INC.

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

000000539504

Policy instance

Insurance contract or identification number	000000539504
Number of Individuals Covered	150
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $6,457
Total amount of fees paid to insurance company	USD $862
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
Welfare Benefit Premiums Paid to Carrier	USD $68,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,457
Amount paid for insurance broker fees	862
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AUSTIN & CO INC

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Company Name:	THE MASTERS SCHOOL
Employer identification number (EIN):	131740472
NAIC Classification:	611000

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C3093805