401k Plan data: ANDERSON & VREELAND INC. BENEFIT PLAN plan

ANDERSON & VREELAND INC. BENEFIT PLAN 401k Plan overview

Plan Name	ANDERSON & VREELAND INC. BENEFIT PLAN
Plan identification number	502

ANDERSON & VREELAND INC. BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover

401k Sponsoring company profile

ANDERSON & VREELAND has sponsored the creation of one or more 401k plans.

Company Name: ANDERSON & VREELAND

Employer identification number (EIN): 222247761

NAIC Classification: 424100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDERSON & VREELAND INC. BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2021-01-01
502 2020-01-01
502 2019-01-01
502 2018-01-01 SHARON LEWITT SHARON LEWITT 2019-07-22
502 2017-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2018-09-28
502 2016-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2017-08-30
502 2015-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2016-09-19
502 2014-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2015-08-06
502 2013-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2014-09-11
502 2012-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2013-10-15
502 2011-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2012-10-15
502 2010-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2011-10-10
502 2009-01-01 HOWARD VREELAND JR. HOWARD VREELAND JR. 2010-10-08

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2022-01-01
502	2021-01-01
502	2020-01-01
502	2019-01-01
502	2018-01-01	SHARON LEWITT	SHARON LEWITT	2019-07-22
502	2017-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2018-09-28
502	2016-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2017-08-30
502	2015-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2016-09-19
502	2014-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2015-08-06
502	2013-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2014-09-11
502	2012-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2013-10-15
502	2011-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2012-10-15
502	2010-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2011-10-10
502	2009-01-01	HOWARD VREELAND JR.	HOWARD VREELAND JR.	2010-10-08

Plan Statistics for ANDERSON & VREELAND INC. BENEFIT PLAN

401k plan membership statisitcs for ANDERSON & VREELAND INC. BENEFIT PLAN

Measure Date Value
2022: ANDERSON & VREELAND INC. BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 261
Total of all active and inactive participants 2022-01-01 261
2021: ANDERSON & VREELAND INC. BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 276
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 275
Total of all active and inactive participants 2021-01-01 275
2020: ANDERSON & VREELAND INC. BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 280
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 276
Total of all active and inactive participants 2020-01-01 276
2019: ANDERSON & VREELAND INC. BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 282
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 280
Total of all active and inactive participants 2019-01-01 280
2018: ANDERSON & VREELAND INC. BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 286
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 282
Total of all active and inactive participants 2018-01-01 282
2017: ANDERSON & VREELAND INC. BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 297
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 286
Total of all active and inactive participants 2017-01-01 286
2016: ANDERSON & VREELAND INC. BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 270
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 297
Total of all active and inactive participants 2016-01-01 297
2015: ANDERSON & VREELAND INC. BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 313
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 270
Total of all active and inactive participants 2015-01-01 270
2014: ANDERSON & VREELAND INC. BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 292
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 313
Total of all active and inactive participants 2014-01-01 313
2013: ANDERSON & VREELAND INC. BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 268
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 292
Total of all active and inactive participants 2013-01-01 292
2012: ANDERSON & VREELAND INC. BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 268
Total of all active and inactive participants 2012-01-01 268
2011: ANDERSON & VREELAND INC. BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 139
Total of all active and inactive participants 2011-01-01 139
2010: ANDERSON & VREELAND INC. BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 136
Total of all active and inactive participants 2010-01-01 136
2009: ANDERSON & VREELAND INC. BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 131
Total of all active and inactive participants 2009-01-01 131

Measure	Date	Value
2022: ANDERSON & VREELAND INC. BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	261
Total of all active and inactive participants	2022-01-01	261
2021: ANDERSON & VREELAND INC. BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	276
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	275
Total of all active and inactive participants	2021-01-01	275
2020: ANDERSON & VREELAND INC. BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	280
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	276
Total of all active and inactive participants	2020-01-01	276
2019: ANDERSON & VREELAND INC. BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	282
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	280
Total of all active and inactive participants	2019-01-01	280
2018: ANDERSON & VREELAND INC. BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	286
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	282
Total of all active and inactive participants	2018-01-01	282
2017: ANDERSON & VREELAND INC. BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	297
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	286
Total of all active and inactive participants	2017-01-01	286
2016: ANDERSON & VREELAND INC. BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	270
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	297
Total of all active and inactive participants	2016-01-01	297
2015: ANDERSON & VREELAND INC. BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	313
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	270
Total of all active and inactive participants	2015-01-01	270
2014: ANDERSON & VREELAND INC. BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	292
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	313
Total of all active and inactive participants	2014-01-01	313
2013: ANDERSON & VREELAND INC. BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	268
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	292
Total of all active and inactive participants	2013-01-01	292
2012: ANDERSON & VREELAND INC. BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	268
Total of all active and inactive participants	2012-01-01	268
2011: ANDERSON & VREELAND INC. BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	139
Total of all active and inactive participants	2011-01-01	139
2010: ANDERSON & VREELAND INC. BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	136
Total of all active and inactive participants	2010-01-01	136
2009: ANDERSON & VREELAND INC. BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	131
Total of all active and inactive participants	2009-01-01	131

Form 5500 Responses for ANDERSON & VREELAND INC. BENEFIT PLAN

2022: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. BENEFIT 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: ANDERSON & VREELAND INC. 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: ANDERSON & VREELAND INC. 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: ANDERSON & VREELAND INC. 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 benefit arrangement – Insurance	Yes
2011: ANDERSON & VREELAND INC. 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 benefit arrangement – Insurance	Yes
2010: ANDERSON & VREELAND INC. 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 benefit arrangement – Insurance	Yes
2009: ANDERSON & VREELAND INC. 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GVTL0B9NZ

Policy instance

Insurance contract or identification number	GVTL0B9NZ
Number of Individuals Covered	39
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,744
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $22,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,744
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: 69868 )

Policy contract number

GLUG0B9NZ

Policy instance

Insurance contract or identification number	GLUG0B9NZ
Number of Individuals Covered	132
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,026
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $15,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,026
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: 69868 )

Policy contract number

GLTD0B9NZ

Policy instance

Insurance contract or identification number	GLTD0B9NZ
Number of Individuals Covered	132
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

907270

Policy instance

Insurance contract or identification number	907270
Number of Individuals Covered	261
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,143
Total amount of fees paid to insurance company	USD $76,976
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,399,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,143
Amount paid for insurance broker fees	76976
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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

Policy contract number

907270

Policy instance

Insurance contract or identification number	907270
Number of Individuals Covered	275
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $10,571
Total amount of fees paid to insurance company	USD $75,446
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,541,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,571
Amount paid for insurance broker fees	75446
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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

Policy contract number

GLTD0B9NZ

Policy instance

Insurance contract or identification number	GLTD0B9NZ
Number of Individuals Covered	132
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

GLUG0B9NZ

Policy instance

Insurance contract or identification number	GLUG0B9NZ
Number of Individuals Covered	132
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,867
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $14,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,867
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: 69868 )

Policy contract number

GVTL0B9NZ

Policy instance

Insurance contract or identification number	GVTL0B9NZ
Number of Individuals Covered	42
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $7,353
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $29,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,353
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: 69868 )

Policy contract number

GVTL0B9NZ

Policy instance

Insurance contract or identification number	GVTL0B9NZ
Number of Individuals Covered	38
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,053
Total amount of fees paid to insurance company	USD $1,006
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,053
Amount paid for insurance broker fees	1006
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0B9NZ

Policy instance

Insurance contract or identification number	GLUG0B9NZ
Number of Individuals Covered	116
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,995
Total amount of fees paid to insurance company	USD $552
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $14,977
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,995
Amount paid for insurance broker fees	552
Additional information about fees paid to insurance broker	AGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLTD0B9NZ

Policy instance

Insurance contract or identification number	GLTD0B9NZ
Number of Individuals Covered	116
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,080
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,044
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	1080
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

907270

Policy instance

Insurance contract or identification number	907270
Number of Individuals Covered	276
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $10,432
Total amount of fees paid to insurance company	USD $73,984
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,527,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,432
Amount paid for insurance broker fees	73984
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

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

Policy contract number

907270

Policy instance

Insurance contract or identification number	907270
Number of Individuals Covered	280
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,330
Total amount of fees paid to insurance company	USD $72,838
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,498,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,330
Amount paid for insurance broker fees	72838
Insurance broker organization code?	3

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

Policy contract number

GLTD0B9NZ

Policy instance

Insurance contract or identification number	GLTD0B9NZ
Number of Individuals Covered	138
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $715
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,857
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	715
Insurance broker organization code?	3

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

Policy contract number

GLUG0B9NZ

Policy instance

Insurance contract or identification number	GLUG0B9NZ
Number of Individuals Covered	138
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,153
Total amount of fees paid to insurance company	USD $383
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $15,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,153
Amount paid for insurance broker fees	383
Insurance broker organization code?	3

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

Policy contract number

GVTL0B9NZ

Policy instance

Insurance contract or identification number	GVTL0B9NZ
Number of Individuals Covered	47
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,182
Total amount of fees paid to insurance company	USD $784
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,182
Amount paid for insurance broker fees	784
Insurance broker organization code?	3

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

Policy contract number

907270

Policy instance

Insurance contract or identification number	907270
Number of Individuals Covered	282
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $559
Total amount of fees paid to insurance company	USD $68,447
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,206,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $559
Amount paid for insurance broker fees	68447
Insurance broker organization code?	3

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

Policy contract number

KM05941784

Policy instance

Insurance contract or identification number	KM05941784
Number of Individuals Covered	424
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,412
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,412
Insurance broker organization code?	3

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

Policy contract number

GLTD0B9NZ

Policy instance

Insurance contract or identification number	GLTD0B9NZ
Number of Individuals Covered	271
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

GLUG0B9NZ

Policy instance

Insurance contract or identification number	GLUG0B9NZ
Number of Individuals Covered	271
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,410
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,410
Insurance broker organization code?	3

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

Policy contract number

GVTL0B9NZ

Policy instance

Insurance contract or identification number	GVTL0B9NZ
Number of Individuals Covered	52
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,220
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,220
Insurance broker organization code?	3

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

Policy contract number

KM05941784

Policy instance

Insurance contract or identification number	KM05941784
Number of Individuals Covered	265
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,445
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,445
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

907270

Policy instance

Insurance contract or identification number	907270
Number of Individuals Covered	286
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $571
Total amount of fees paid to insurance company	USD $64,301
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,339,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $571
Amount paid for insurance broker fees	64301
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

000010186417

Policy instance

Insurance contract or identification number	000010186417
Number of Individuals Covered	142
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,570
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,570
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

000010186418

Policy instance

Insurance contract or identification number	000010186418
Number of Individuals Covered	143
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,877
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,877
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYDO66885

Policy instance

Insurance contract or identification number	NYDO66885
Number of Individuals Covered	1
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $13
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $87
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13
Insurance broker name	RK HUGHES INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-041467

Policy instance

Insurance contract or identification number	010-041467
Number of Individuals Covered	107
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,078
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,078
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

000010186418

Policy instance

Insurance contract or identification number	000010186418
Number of Individuals Covered	146
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,036
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,036
Insurance broker name	S J BENEFITS GROUP INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P43995 P44009

Policy instance

Insurance contract or identification number	P43995 P44009
Number of Individuals Covered	270
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $48,293
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,233,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,293
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYDO66885

Policy instance

Insurance contract or identification number	NYDO66885
Number of Individuals Covered	2
Insurance policy start date	2015-07-01
Insurance policy end date	2016-07-01
Total amount of commissions paid to insurance broker	USD $12
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $77
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12
Insurance broker organization code?	3
Insurance broker name	RK HUGHES INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3628203

Policy instance

Insurance contract or identification number	E3628203
Number of Individuals Covered	2
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $61
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SUPPLEMENTARY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $1,054
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
Insurance broker organization code?	3
Insurance broker name	ROBERT E ELLIS

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

Policy contract number

000010186417

Policy instance

Insurance contract or identification number	000010186417
Number of Individuals Covered	146
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,672
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,672
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

000010186417

Policy instance

Insurance contract or identification number	000010186417
Number of Individuals Covered	162
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,529
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 $16,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,529
Insurance broker name	S J BENEFITS GROUP INC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P43995 P44009

Policy instance

Insurance contract or identification number	P43995 P44009
Number of Individuals Covered	313
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $48,755
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 $1,244,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,755
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYDO66885

Policy instance

Insurance contract or identification number	NYDO66885
Number of Individuals Covered	2
Insurance policy start date	2014-07-01
Insurance policy end date	2015-07-01
Total amount of commissions paid to insurance broker	USD $12
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	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $77
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12
Insurance broker organization code?	3
Insurance broker name	RK HUGHES INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3628203

Policy instance

Insurance contract or identification number	E3628203
Number of Individuals Covered	2
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $66
Total amount of fees paid to insurance company	USD $11
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	SUPPLEMENTARY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $1,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43
Amount paid for insurance broker fees	8
Insurance broker organization code?	3
Insurance broker name	ROBERT ELLIS

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

Policy contract number

000010186418

Policy instance

Insurance contract or identification number	000010186418
Number of Individuals Covered	161
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,842
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 $25,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,842
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

00001D21454

Policy instance

Insurance contract or identification number	00001D21454
Number of Individuals Covered	115
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,204
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 $102,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,204
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F018356

Policy instance

Insurance contract or identification number	F018356
Number of Individuals Covered	180
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,630
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	ADD
Welfare Benefit Premiums Paid to Carrier	USD $58,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,630
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

00001D21454

Policy instance

Insurance contract or identification number	00001D21454
Number of Individuals Covered	106
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Total amount of commissions paid to insurance broker	USD $9,613
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 $96,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,613
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYDO66885

Policy instance

Insurance contract or identification number	NYDO66885
Number of Individuals Covered	2
Insurance policy start date	2013-07-01
Insurance policy end date	2014-07-01
Total amount of commissions paid to insurance broker	USD $12
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	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $77
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12
Insurance broker organization code?	3
Insurance broker name	RK HUGHES INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3628203

Policy instance

Insurance contract or identification number	E3628203
Number of Individuals Covered	2
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $61
Total amount of fees paid to insurance company	USD $13
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	SUPPLEMENTARY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $1,054
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	11
Insurance broker organization code?	3
Insurance broker name	ROBERT ELLIS

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P43995 P44009

Policy instance

Insurance contract or identification number	P43995 P44009
Number of Individuals Covered	292
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $45,461
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 $1,086,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,041
Insurance broker organization code?	3
Insurance broker name	E BROKER QUOTE LLC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F018356

Policy instance

Insurance contract or identification number	F018356
Number of Individuals Covered	145
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,700
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	ADD
Welfare Benefit Premiums Paid to Carrier	USD $58,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,700
Insurance broker name	SJ BENEFITS GROUP

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

P43995 P44009

Policy instance

Insurance contract or identification number	P43995 P44009
Number of Individuals Covered	268
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $63,544
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 $1,105,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,969
Insurance broker name	E BROKER QUOTE LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYDO66885

Policy instance

Insurance contract or identification number	NYDO66885
Number of Individuals Covered	2
Insurance policy start date	2011-07-01
Insurance policy end date	2012-07-01
Total amount of commissions paid to insurance broker	USD $12
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	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $77
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12
Insurance broker name	R K HUGHES INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3628203

Policy instance

Insurance contract or identification number	E3628203
Number of Individuals Covered	2
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $165
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	SUPPLEMENTARY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $1,119
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
Amount paid for insurance broker fees	15
Insurance broker name	RAYMOND WILLIAM SCHAEFER

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

Policy contract number

00001D21454

Policy instance

Insurance contract or identification number	00001D21454
Number of Individuals Covered	102
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $8,575
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 $85,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,575
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

000010099046

Policy instance

Insurance contract or identification number	000010099046
Number of Individuals Covered	138
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,618
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 $15,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3628203

Policy instance

Insurance contract or identification number	E3628203
Number of Individuals Covered	3
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $734
Total amount of fees paid to insurance company	USD $97
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	SUPPLEMENTARY INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $1,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYDO66885

Policy instance

Insurance contract or identification number	NYDO66885
Number of Individuals Covered	2
Insurance policy start date	2010-07-01
Insurance policy end date	2011-07-01
Total amount of commissions paid to insurance broker	USD $12
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	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $79
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

000010099047

Policy instance

Insurance contract or identification number	000010099047
Number of Individuals Covered	139
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,806
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 $20,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00001D21454

Policy instance

Insurance contract or identification number	00001D21454
Number of Individuals Covered	105
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $8,469
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 $84,689
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

718302

Policy instance

Insurance contract or identification number	718302
Number of Individuals Covered	109
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $55,572
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 $1,111,435
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

718302

Policy instance

Insurance contract or identification number	718302
Number of Individuals Covered	108
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $55,035
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 $1,009,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,035
Insurance broker organization code?	3
Insurance broker name	S J BENEFITS GROUP INC

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

Policy contract number

000010099046

Policy instance

Insurance contract or identification number	000010099046
Number of Individuals Covered	136
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,658
Total amount of fees paid to insurance company	USD $712
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 $15,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,658
Insurance broker organization code?	3
Amount paid for insurance broker fees	712
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	COR MAC INC

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

Policy contract number

000010099047

Policy instance

Insurance contract or identification number	000010099047
Number of Individuals Covered	137
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,881
Total amount of fees paid to insurance company	USD $962
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 $21,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,881
Insurance broker organization code?	3
Amount paid for insurance broker fees	962
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	COR MAC INC

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Company Name:	ANDERSON & VREELAND
Employer identification number (EIN):	222247761
NAIC Classification:	424100