401k Plan data: PRESSLEY RIDGE HEALTH INSURANCE PLAN plan

PRESSLEY RIDGE HEALTH INSURANCE PLAN 401k Plan overview

Plan Name	PRESSLEY RIDGE HEALTH INSURANCE PLAN
Plan identification number	501

PRESSLEY RIDGE HEALTH INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

EMPLOYEE BENEFIT PLAN OF PRESSLEY RIDGE has sponsored the creation of one or more 401k plans.

Company Name: EMPLOYEE BENEFIT PLAN OF PRESSLEY RIDGE

Employer identification number (EIN): 250965460

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about EMPLOYEE BENEFIT PLAN OF PRESSLEY RIDGE

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2006-12-15

Company Identification Number: 0800746540

Legal Registered Office Address: 11 COMMERCE DR STE 200

MORGANTOWN
United States of America (USA)
26501

More information about EMPLOYEE BENEFIT PLAN OF PRESSLEY RIDGE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRESSLEY RIDGE HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 DOUGLAS A. MULLINS 2023-10-10
501 2021-01-01 DOUGLAS A. MULLINS 2022-10-10
501 2020-01-01 DOUGLAS A. MULLINS 2021-09-22
501 2019-01-01 DOUGLAS A. MULLINS 2020-10-06
501 2018-01-01 DOUGLAS A. MULLINS 2019-10-10
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 EDWARD SZCZYPINSKI EDWARD SZCZYPINSKI 2013-10-09
501 2011-01-01 EDWARD SZCZYPINSKI EDWARD SZCZYPINSKI 2012-10-29
501 2010-01-01 EDWARD SZCZYPINSKI
501 2009-01-01 EDWARD SZCZYPINSKI

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	DOUGLAS A. MULLINS	2023-10-10
501	2021-01-01	DOUGLAS A. MULLINS	2022-10-10
501	2020-01-01	DOUGLAS A. MULLINS	2021-09-22
501	2019-01-01	DOUGLAS A. MULLINS	2020-10-06
501	2018-01-01	DOUGLAS A. MULLINS	2019-10-10
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	EDWARD SZCZYPINSKI		EDWARD SZCZYPINSKI	2013-10-09
501	2011-01-01	EDWARD SZCZYPINSKI		EDWARD SZCZYPINSKI	2012-10-29
501	2010-01-01	EDWARD SZCZYPINSKI
501	2009-01-01	EDWARD SZCZYPINSKI

Plan Statistics for PRESSLEY RIDGE HEALTH INSURANCE PLAN

401k plan membership statisitcs for PRESSLEY RIDGE HEALTH INSURANCE PLAN

Measure Date Value
2022: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 908
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 842
Number of retired or separated participants receiving benefits 2022-01-01 5
Total of all active and inactive participants 2022-01-01 847
2021: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 967
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 903
Number of retired or separated participants receiving benefits 2021-01-01 5
Total of all active and inactive participants 2021-01-01 908
2020: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 961
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 963
Number of retired or separated participants receiving benefits 2020-01-01 4
Total of all active and inactive participants 2020-01-01 967
2019: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,076
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 954
Number of retired or separated participants receiving benefits 2019-01-01 7
Total of all active and inactive participants 2019-01-01 961
2018: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,078
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,066
Number of retired or separated participants receiving benefits 2018-01-01 10
Total of all active and inactive participants 2018-01-01 1,076
2017: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,062
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,073
Number of retired or separated participants receiving benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 1,078
2016: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,027
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,060
Number of retired or separated participants receiving benefits 2016-01-01 2
Total of all active and inactive participants 2016-01-01 1,062
2015: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,026
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 738
Total of all active and inactive participants 2015-01-01 738
2014: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 845
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 732
Total of all active and inactive participants 2014-01-01 732
2013: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 875
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 702
Total of all active and inactive participants 2013-01-01 702
2012: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 842
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 875
Total of all active and inactive participants 2012-01-01 875
2011: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 843
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 842
Total of all active and inactive participants 2011-01-01 842
2010: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 863
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 843
Total of all active and inactive participants 2010-01-01 843
2009: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 812
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 863
Total of all active and inactive participants 2009-01-01 863

Measure	Date	Value
2022: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	908
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	842
Number of retired or separated participants receiving benefits	2022-01-01	5
Total of all active and inactive participants	2022-01-01	847
2021: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	967
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	903
Number of retired or separated participants receiving benefits	2021-01-01	5
Total of all active and inactive participants	2021-01-01	908
2020: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	961
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	963
Number of retired or separated participants receiving benefits	2020-01-01	4
Total of all active and inactive participants	2020-01-01	967
2019: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,076
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	954
Number of retired or separated participants receiving benefits	2019-01-01	7
Total of all active and inactive participants	2019-01-01	961
2018: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,078
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,066
Number of retired or separated participants receiving benefits	2018-01-01	10
Total of all active and inactive participants	2018-01-01	1,076
2017: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,062
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,073
Number of retired or separated participants receiving benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	1,078
2016: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,027
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,060
Number of retired or separated participants receiving benefits	2016-01-01	2
Total of all active and inactive participants	2016-01-01	1,062
2015: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,026
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	738
Total of all active and inactive participants	2015-01-01	738
2014: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	845
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	732
Total of all active and inactive participants	2014-01-01	732
2013: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	875
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	702
Total of all active and inactive participants	2013-01-01	702
2012: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	842
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	875
Total of all active and inactive participants	2012-01-01	875
2011: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	843
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	842
Total of all active and inactive participants	2011-01-01	842
2010: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	863
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	843
Total of all active and inactive participants	2010-01-01	843
2009: PRESSLEY RIDGE HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	812
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	863
Total of all active and inactive participants	2009-01-01	863

Form 5500 Responses for PRESSLEY RIDGE HEALTH INSURANCE PLAN

2022: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: PRESSLEY RIDGE HEALTH INSURANCE 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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: PRESSLEY RIDGE HEALTH INSURANCE 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: PRESSLEY RIDGE HEALTH INSURANCE 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: PRESSLEY RIDGE HEALTH INSURANCE 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: PRESSLEY RIDGE HEALTH INSURANCE 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: PRESSLEY RIDGE HEALTH INSURANCE 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: PRESSLEY RIDGE HEALTH INSURANCE 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 LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010220420

Policy instance

Insurance contract or identification number	000010220420
Number of Individuals Covered	198
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,446
Total amount of fees paid to insurance company	USD $116
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $88,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,446
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000010220419

Policy instance

Insurance contract or identification number	000010220419
Number of Individuals Covered	762
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5,081
Total amount of fees paid to insurance company	USD $116
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,081
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000010220418

Policy instance

Insurance contract or identification number	000010220418
Number of Individuals Covered	760
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,401
Total amount of fees paid to insurance company	USD $116
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $68,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,401
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

LYTLE BEHAVIORAL HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

3540854

Policy instance

Insurance contract or identification number	3540854
Number of Individuals Covered	903
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $14,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	622
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
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1150
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 $38
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $355,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	38
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1229
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 $23
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $399,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	660
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
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LYTLE BEHAVIORAL HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

3540854

Policy instance

Insurance contract or identification number	3540854
Number of Individuals Covered	963
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $15,092
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

000010220418

Policy instance

Insurance contract or identification number	000010220418
Number of Individuals Covered	822
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,140
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $82,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,140
Insurance broker organization code?	3

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

Policy contract number

000010220419

Policy instance

Insurance contract or identification number	000010220419
Number of Individuals Covered	825
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,084
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,084
Insurance broker organization code?	3

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

Policy contract number

000010220420

Policy instance

Insurance contract or identification number	000010220420
Number of Individuals Covered	203
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,043
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $100,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,043
Insurance broker organization code?	3

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1304
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 $18
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $405,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	18
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	722
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 $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LYTLE BEHAVIORAL HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

3540854

Policy instance

Insurance contract or identification number	3540854
Number of Individuals Covered	963
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 $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $15,092
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

000010220418

Policy instance

Insurance contract or identification number	000010220418
Number of Individuals Covered	884
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,622
Total amount of fees paid to insurance company	USD $3,441
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $72,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,622
Amount paid for insurance broker fees	3441
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000010220419

Policy instance

Insurance contract or identification number	000010220419
Number of Individuals Covered	884
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,995
Total amount of fees paid to insurance company	USD $4,661
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,995
Amount paid for insurance broker fees	4661
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000010220420

Policy instance

Insurance contract or identification number	000010220420
Number of Individuals Covered	236
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,192
Total amount of fees paid to insurance company	USD $3,989
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $103,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,192
Amount paid for insurance broker fees	3989
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1342
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 $46
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $431,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	46
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	747
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 $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFESOLUTIONS (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

500000763

Policy instance

Insurance contract or identification number	500000763
Number of Individuals Covered	1073
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 $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $11,089
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

000010220418

Policy instance

Insurance contract or identification number	000010220418
Number of Individuals Covered	951
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,621
Total amount of fees paid to insurance company	USD $239
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND LIFE
Welfare Benefit Premiums Paid to Carrier	USD $72,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,621
Amount paid for insurance broker fees	239
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000010220419

Policy instance

Insurance contract or identification number	000010220419
Number of Individuals Covered	951
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,987
Total amount of fees paid to insurance company	USD $280
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,987
Amount paid for insurance broker fees	280
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000010220420

Policy instance

Insurance contract or identification number	000010220420
Number of Individuals Covered	236
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,263
Total amount of fees paid to insurance company	USD $233
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $85,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,263
Amount paid for insurance broker fees	233
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1342
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 $20
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $447,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	20
Insurance broker organization code?	3

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	739
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
Vision Insurance Welfare Benefit	Yes
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

000010220418

Policy instance

Insurance contract or identification number	000010220418
Number of Individuals Covered	981
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,773
Total amount of fees paid to insurance company	USD $283
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $95,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,773
Amount paid for insurance broker fees	283
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

LIFESOLUTIONS (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

500000763

Policy instance

Insurance contract or identification number	500000763
Number of Individuals Covered	1073
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $24,722
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

000010220419

Policy instance

Insurance contract or identification number	000010220419
Number of Individuals Covered	938
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,607
Total amount of fees paid to insurance company	USD $354
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,607
Amount paid for insurance broker fees	354
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000010220420

Policy instance

Insurance contract or identification number	000010220420
Number of Individuals Covered	204
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,653
Total amount of fees paid to insurance company	USD $323
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $93,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,653
Amount paid for insurance broker fees	323
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	336
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,678
Total amount of fees paid to insurance company	USD $157
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,678
Amount paid for insurance broker fees	157
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	273
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,570
Total amount of fees paid to insurance company	USD $2,782
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,570
Amount paid for insurance broker fees	2782
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS

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

Policy contract number

000010220420

Policy instance

Insurance contract or identification number	000010220420
Number of Individuals Covered	273
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,228
Total amount of fees paid to insurance company	USD $4,570
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $64,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,228
Amount paid for insurance broker fees	4570
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS

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

Policy contract number

000010220419

Policy instance

Insurance contract or identification number	000010220419
Number of Individuals Covered	955
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,544
Total amount of fees paid to insurance company	USD $4,855
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,886
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	4855
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS

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

Policy contract number

000010220418

Policy instance

Insurance contract or identification number	000010220418
Number of Individuals Covered	998
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,829
Total amount of fees paid to insurance company	USD $3,823
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D AND DEPENDENT LIFE
Welfare Benefit Premiums Paid to Carrier	USD $56,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,829
Amount paid for insurance broker fees	3823
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS

LIFESOLUTIONS (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

500000763

Policy instance

Insurance contract or identification number	500000763
Number of Individuals Covered	1073
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $16,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	727
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1288
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $17
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $420,690
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	17
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX964307

Policy instance

Insurance contract or identification number	FLX964307
Number of Individuals Covered	1422
Insurance policy start date	2014-10-01
Insurance policy end date	2015-10-01
Total amount of commissions paid to insurance broker	USD $4,648
Total amount of fees paid to insurance company	USD $2,053
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $92,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,648
Amount paid for insurance broker fees	2053
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 965908

Policy instance

Insurance contract or identification number	OK 965908
Number of Individuals Covered	975
Insurance policy start date	2014-10-01
Insurance policy end date	2015-10-01
Total amount of commissions paid to insurance broker	USD $2,054
Total amount of fees paid to insurance company	USD $341
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $13,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,054
Amount paid for insurance broker fees	341
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT960998

Policy instance

Insurance contract or identification number	VDT960998
Number of Individuals Covered	222
Insurance policy start date	2014-10-01
Insurance policy end date	2015-10-01
Total amount of commissions paid to insurance broker	USD $3,440
Total amount of fees paid to insurance company	USD $1,517
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,440
Amount paid for insurance broker fees	1517
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 963029

Policy instance

Insurance contract or identification number	LK 963029
Number of Individuals Covered	975
Insurance policy start date	2014-10-01
Insurance policy end date	2015-10-01
Total amount of commissions paid to insurance broker	USD $3,441
Total amount of fees paid to insurance company	USD $1,727
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,441
Amount paid for insurance broker fees	1727
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	765
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1382
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $435,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFESOLUTIONS (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

500000763

Policy instance

Insurance contract or identification number	500000763
Number of Individuals Covered	1027
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $22,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	762
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1444
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $430,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 963029

Policy instance

Insurance contract or identification number	LK 963029
Number of Individuals Covered	845
Insurance policy start date	2013-10-01
Insurance policy end date	2014-10-01
Total amount of commissions paid to insurance broker	USD $3,928
Total amount of fees paid to insurance company	USD $2,517
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 $78,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,928
Amount paid for insurance broker fees	2517
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT960998

Policy instance

Insurance contract or identification number	VDT960998
Number of Individuals Covered	186
Insurance policy start date	2013-10-01
Insurance policy end date	2014-10-01
Total amount of commissions paid to insurance broker	USD $3,265
Total amount of fees paid to insurance company	USD $1,612
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 $65,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,265
Amount paid for insurance broker fees	1612
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 965908

Policy instance

Insurance contract or identification number	OK 965908
Number of Individuals Covered	845
Insurance policy start date	2013-10-01
Insurance policy end date	2014-10-01
Total amount of commissions paid to insurance broker	USD $2,248
Total amount of fees paid to insurance company	USD $438
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	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $14,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,248
Amount paid for insurance broker fees	438
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX964307

Policy instance

Insurance contract or identification number	FLX964307
Number of Individuals Covered	867
Insurance policy start date	2013-10-01
Insurance policy end date	2014-10-01
Total amount of commissions paid to insurance broker	USD $4,594
Total amount of fees paid to insurance company	USD $2,731
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 $91,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,594
Amount paid for insurance broker fees	2731
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT960998

Policy instance

Insurance contract or identification number	VDT960998
Number of Individuals Covered	173
Insurance policy start date	2012-10-01
Insurance policy end date	2013-10-01
Total amount of commissions paid to insurance broker	USD $4,809
Total amount of fees paid to insurance company	USD $409
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 $55,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,809
Amount paid for insurance broker fees	409
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 963029

Policy instance

Insurance contract or identification number	LK 963029
Number of Individuals Covered	860
Insurance policy start date	2012-10-01
Insurance policy end date	2013-10-01
Total amount of commissions paid to insurance broker	USD $7,824
Total amount of fees paid to insurance company	USD $669
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 $89,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,824
Amount paid for insurance broker fees	669
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	752
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1299
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $428,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

DK 965908

Policy instance

Insurance contract or identification number	DK 965908
Number of Individuals Covered	860
Insurance policy start date	2012-10-01
Insurance policy end date	2013-10-01
Total amount of commissions paid to insurance broker	USD $2,174
Total amount of fees paid to insurance company	USD $95
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	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $14,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,174
Amount paid for insurance broker fees	95
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX964307

Policy instance

Insurance contract or identification number	FLX964307
Number of Individuals Covered	1203
Insurance policy start date	2012-10-01
Insurance policy end date	2013-10-01
Total amount of commissions paid to insurance broker	USD $7,831
Total amount of fees paid to insurance company	USD $644
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 $92,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,831
Amount paid for insurance broker fees	644
Additional information about fees paid to insurance broker	OTHER SERVICES
Insurance broker organization code?	3
Insurance broker name	SAGEWELL PARTNERS INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK963029

Policy instance

Insurance contract or identification number	LK963029
Insurance policy start date	2011-10-01
Insurance policy end date	2012-10-01
Total amount of commissions paid to insurance broker	USD $36,563
Total amount of fees paid to insurance company	USD $4,448
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,563
Amount paid for insurance broker fees	4448
Insurance broker name	BBR SERVICES, LP

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	791
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
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1300
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
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $432,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK963029

Policy instance

Insurance contract or identification number	LK963029
Number of Individuals Covered	842
Insurance policy start date	2011-10-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,434
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

143576

Policy instance

Insurance contract or identification number	143576
Number of Individuals Covered	842
Insurance policy start date	2011-01-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $31,729
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	785
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

0101281

Policy instance

Insurance contract or identification number	0101281
Number of Individuals Covered	1263
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $383,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

143576

Policy instance

Insurance contract or identification number	143576
Number of Individuals Covered	843
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $38,967
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,277
Insurance broker organization code?	3
Insurance broker name	JOHN W. SELTZER

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )

Policy contract number

396

Policy instance

Insurance contract or identification number	396
Number of Individuals Covered	792
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

101281

Policy instance

Insurance contract or identification number	101281
Number of Individuals Covered	1294
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $393,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	EMPLOYEE BENEFIT PLAN OF PRESSLEY RIDGE
Employer identification number (EIN):	250965460
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2006-12-15
Company Identification Number:	0800746540
Legal Registered Office Address:	11 COMMERCE DR STE 200 MORGANTOWN United States of America (USA) 26501