GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number	501

GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

GLENN O. HAWBAKER, INC. has sponsored the creation of one or more 401k plans.

Company Name:	GLENN O. HAWBAKER, INC.
Employer identification number (EIN):	251150293
NAIC Classification:	237310
NAIC Description:	Highway, Street, and Bridge Construction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	CASSANDRA PICK	2023-10-06
501	2021-01-01	CASSANDRA PICK	2022-10-07
501	2020-01-01	CASSANDRA PICK	2021-10-14
501	2019-01-01	CASSANDRA PICK	2020-10-14
501	2018-01-01	CASSANDRA PICK	2019-10-14
501	2017-01-01
501	2016-01-01
501	2016-01-01	CASSANDRA PICK	2018-10-16
501	2015-01-01	MATT HANEY
501	2014-01-01	MATT HANEY
501	2013-06-01	MATT HANEY
501	2012-06-01	MATT HANEY
501	2011-06-01	MATT HANEY
501	2010-06-01	MATT HANEY
501	2010-01-01	MATT HANEY
501	2010-01-01	LINDA S. MATHIEU, CPA
501	2010-01-01	LINDA S. MATHIEU, CPA
501	2009-01-01	MATT HANEY
501	2009-01-01	LINDA S. MATHIEU, PRES.

Plan Statistics for GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN

Measure	Date	Value
2022: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	944
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	969
Number of retired or separated participants receiving benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	969
Total participants	2022-01-01	969
2021: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,107
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	941
Number of retired or separated participants receiving benefits	2021-01-01	3
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	944
Total participants	2021-01-01	944
2020: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,289
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,101
Number of retired or separated participants receiving benefits	2020-01-01	6
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	1,107
Total participants	2020-01-01	1,107
2019: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,272
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,284
Number of retired or separated participants receiving benefits	2019-01-01	5
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	1,289
Number of employers contributing to the scheme	2019-01-01	0
2018: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,247
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,272
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	1,272
Number of employers contributing to the scheme	2018-01-01	0
2017: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,265
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,244
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	1,247
2016: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,271
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,244
Number of retired or separated participants receiving benefits	2016-01-01	21
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	1,265
2015: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,045
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,246
Number of retired or separated participants receiving benefits	2015-01-01	25
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1,271
2014: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,081
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,037
Number of retired or separated participants receiving benefits	2014-01-01	8
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	1,045
2013: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	1,197
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	1,081
Number of retired or separated participants receiving benefits	2013-06-01	16
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	1,097
2012: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	1,242
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	1,197
Number of retired or separated participants receiving benefits	2012-06-01	88
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	1,285
2011: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	1,082
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	1,251
Number of retired or separated participants receiving benefits	2011-06-01	25
Number of other retired or separated participants entitled to future benefits	2011-06-01	0
Total of all active and inactive participants	2011-06-01	1,276
2010: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-06-01	1,146
Total number of active participants reported on line 7a of the Form 5500	2010-06-01	1,082
Number of retired or separated participants receiving benefits	2010-06-01	17
Number of other retired or separated participants entitled to future benefits	2010-06-01	0
Total of all active and inactive participants	2010-06-01	1,099
Total participants, beginning-of-year	2010-01-01	1,363
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,363
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	1,363
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	1,146
Number of participants with account balances	2010-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,273
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,273
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	1,273
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,273
Number of participants with account balances	2009-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN

Measure	Date	Value
2022 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$114,939
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$105,969
Total income from all sources (including contributions)	2022-12-31	$20,802,234
Total of all expenses incurred	2022-12-31	$19,852,092
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$19,150,829
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$19,817,681
Value of total assets at end of year	2022-12-31	$10,394,254
Value of total assets at beginning of year	2022-12-31	$9,435,142
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$701,263
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$1,861,346
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$497,629
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$724,258
Other income not declared elsewhere	2022-12-31	$984,553
Liabilities. Value of operating payables at end of year	2022-12-31	$114,939
Liabilities. Value of operating payables at beginning of year	2022-12-31	$105,969
Total non interest bearing cash at end of year	2022-12-31	$9,896,625
Total non interest bearing cash at beginning of year	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$950,142
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$10,279,315
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$9,329,173
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$8,710,884
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$8,710,884
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$2,789,421
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$17,956,335
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$16,361,408
Contract administrator fees	2022-12-31	$701,263
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	No
Did the plan have assets held for investment	2022-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	BAKER TILLY US, LLP
Accountancy firm EIN	2022-12-31	390859910
2021 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$105,969
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$67,416
Total income from all sources (including contributions)	2021-12-31	$13,741,834
Total of all expenses incurred	2021-12-31	$18,423,737
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$17,670,593
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$12,826,579
Value of total assets at end of year	2021-12-31	$9,435,142
Value of total assets at beginning of year	2021-12-31	$14,078,492
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$753,144
Total interest from all sources	2021-12-31	$1,118
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$1,852,399
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$724,258
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$740,173
Other income not declared elsewhere	2021-12-31	$914,137
Liabilities. Value of operating payables at end of year	2021-12-31	$105,969
Liabilities. Value of operating payables at beginning of year	2021-12-31	$67,416
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-4,681,903
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$9,329,173
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$14,011,076
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$8,710,884
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$13,338,319
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$13,338,319
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$1,118
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$2,560,720
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$10,974,180
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$15,109,873
Contract administrator fees	2021-12-31	$753,144
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	BAKER TILLY US, LLP
Accountancy firm EIN	2021-12-31	390859910
2020 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$67,416
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$151,320
Total income from all sources (including contributions)	2020-12-31	$16,582,338
Total of all expenses incurred	2020-12-31	$19,223,462
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$18,370,122
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$15,884,158
Value of total assets at end of year	2020-12-31	$14,078,492
Value of total assets at beginning of year	2020-12-31	$16,803,520
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$853,340
Total interest from all sources	2020-12-31	$34,919
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,972,600
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$740,173
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$922,159
Other income not declared elsewhere	2020-12-31	$663,261
Liabilities. Value of operating payables at end of year	2020-12-31	$67,416
Liabilities. Value of operating payables at beginning of year	2020-12-31	$151,320
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-2,641,124
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$14,011,076
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$16,652,200
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$13,338,319
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$15,881,361
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$15,881,361
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$34,919
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$2,750,019
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$13,911,558
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$15,620,103
Contract administrator fees	2020-12-31	$853,340
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	No
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	BAKER TILLY US, LLP
Accountancy firm EIN	2020-12-31	390859910
2019 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$151,320
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$151,320
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$448,943
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$448,943
Total income from all sources (including contributions)	2019-12-31	$21,289,040
Total income from all sources (including contributions)	2019-12-31	$21,289,040
Total of all expenses incurred	2019-12-31	$20,339,703
Total of all expenses incurred	2019-12-31	$20,339,703
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$19,429,233
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$19,429,233
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$20,572,835
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$20,572,835
Value of total assets at end of year	2019-12-31	$16,803,520
Value of total assets at end of year	2019-12-31	$16,803,520
Value of total assets at beginning of year	2019-12-31	$16,151,806
Value of total assets at beginning of year	2019-12-31	$16,151,806
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$910,470
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$910,470
Total interest from all sources	2019-12-31	$44,817
Total interest from all sources	2019-12-31	$44,817
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$2,541,550
Contributions received from participants	2019-12-31	$2,541,550
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$922,159
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$922,159
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$502,631
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$502,631
Other income not declared elsewhere	2019-12-31	$671,388
Other income not declared elsewhere	2019-12-31	$671,388
Liabilities. Value of operating payables at end of year	2019-12-31	$151,320
Liabilities. Value of operating payables at end of year	2019-12-31	$151,320
Liabilities. Value of operating payables at beginning of year	2019-12-31	$448,943
Liabilities. Value of operating payables at beginning of year	2019-12-31	$448,943
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$15,607,488
Total non interest bearing cash at beginning of year	2019-12-31	$15,607,488
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$949,337
Value of net income/loss	2019-12-31	$949,337
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$16,652,200
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$16,652,200
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$15,702,863
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$15,702,863
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$15,881,361
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$15,881,361
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$44,817
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$44,817
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$2,750,255
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$2,750,255
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$18,031,285
Contributions received in cash from employer	2019-12-31	$18,031,285
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$41,687
Employer contributions (assets) at beginning of year	2019-12-31	$41,687
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$16,678,978
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$16,678,978
Contract administrator fees	2019-12-31	$910,470
Contract administrator fees	2019-12-31	$910,470
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	BAKER TILLY US, LLP
Accountancy firm name	2019-12-31	BAKER TILLY US, LLP
Accountancy firm EIN	2019-12-31	390859910
Accountancy firm EIN	2019-12-31	390859910
2018 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$448,943
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$339,021
Total income from all sources (including contributions)	2018-12-31	$17,621,200
Total of all expenses incurred	2018-12-31	$18,553,115
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$17,882,511
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$17,140,367
Value of total assets at end of year	2018-12-31	$16,151,806
Value of total assets at beginning of year	2018-12-31	$16,973,799
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$670,604
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$2,357,867
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$502,631
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$950,486
Other income not declared elsewhere	2018-12-31	$480,833
Liabilities. Value of operating payables at end of year	2018-12-31	$448,943
Liabilities. Value of operating payables at beginning of year	2018-12-31	$111,455
Total non interest bearing cash at end of year	2018-12-31	$15,607,488
Total non interest bearing cash at beginning of year	2018-12-31	$16,023,313
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-931,915
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$15,702,863
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$16,634,778
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$2,451,859
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$14,782,500
Employer contributions (assets) at end of year	2018-12-31	$41,687
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$15,430,652
Contract administrator fees	2018-12-31	$670,604
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$227,566
Did the plan have assets held for investment	2018-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2018-12-31	390859910
2017 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$339,021
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$191,639
Total income from all sources (including contributions)	2017-12-31	$24,749,032
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$18,446,204
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$17,606,125
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$24,749,032
Value of total assets at end of year	2017-12-31	$16,973,799
Value of total assets at beginning of year	2017-12-31	$10,523,589
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$840,079
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$840,079
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$2,494,139
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$381,733
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$950,486
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$10,515,586
Liabilities. Value of operating payables at end of year	2017-12-31	$111,455
Total non interest bearing cash at end of year	2017-12-31	$16,023,313
Total non interest bearing cash at beginning of year	2017-12-31	$8,003
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$6,302,828
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$16,634,778
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$10,331,950
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$1,807,334
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$21,873,160
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$15,798,791
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$227,566
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$191,639
Did the plan have assets held for investment	2017-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2017-12-31	390859910
2016 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$191,639
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$173,386
Total income from all sources (including contributions)	2016-12-31	$18,252,945
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$18,579,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$17,740,135
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$18,252,945
Value of total assets at end of year	2016-12-31	$10,255,430
Value of total assets at beginning of year	2016-12-31	$10,563,538
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$839,171
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$839,171
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$2,919,411
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$271,740
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$10,247,427
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$525,535
Total non interest bearing cash at end of year	2016-12-31	$8,003
Total non interest bearing cash at beginning of year	2016-12-31	$10,038,003
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-326,361
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$10,063,791
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$10,390,152
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$1,690,592
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$15,061,794
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$16,049,543
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$191,639
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$173,386
Did the plan have assets held for investment	2016-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2016-12-31	390859910
2015 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$173,386
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$22,650,830
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$16,705,647
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$15,904,969
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$22,650,830
Value of total assets at end of year	2015-12-31	$10,563,538
Value of total assets at beginning of year	2015-12-31	$4,444,969
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$800,678
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$800,678
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$3,086,441
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$525,535
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$4,426,766
Liabilities. Value of operating payables at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$10,038,003
Total non interest bearing cash at beginning of year	2015-12-31	$18,203
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Income. Non cash contributions	2015-12-31	$273,107
Value of net income/loss	2015-12-31	$5,945,183
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$10,390,152
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,444,969
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$1,599,258
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$19,291,282
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$14,305,711
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$173,386
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2015-12-31	390859910
2014 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$139,313
Total income from all sources (including contributions)	2014-12-31	$21,378,012
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$17,310,803
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$16,342,255
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$21,378,012
Value of total assets at end of year	2014-12-31	$4,444,969
Value of total assets at beginning of year	2014-12-31	$517,073
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$968,548
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$968,548
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$2,859,540
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$4,426,766
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$352,765
Liabilities. Value of operating payables at end of year	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$130,207
Total non interest bearing cash at end of year	2014-12-31	$18,203
Total non interest bearing cash at beginning of year	2014-12-31	$164,308
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Income. Non cash contributions	2014-12-31	$176,766
Value of net income/loss	2014-12-31	$4,067,209
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,444,969
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$377,760
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$16,342,255
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$18,341,706
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$9,106
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2014-12-31	390859910
2013 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$139,313
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$64,509
Total income from all sources (including contributions)	2013-12-31	$7,610,177
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$7,538,339
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$6,987,150
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$7,610,177
Value of total assets at end of year	2013-12-31	$517,073
Value of total assets at beginning of year	2013-12-31	$370,431
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$551,189
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$551,189
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,696,664
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$5,821,118
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$352,765
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$362,228
Liabilities. Value of operating payables at end of year	2013-12-31	$130,207
Liabilities. Value of operating payables at beginning of year	2013-12-31	$64,509
Total non interest bearing cash at end of year	2013-12-31	$164,308
Total non interest bearing cash at beginning of year	2013-12-31	$8,203
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Income. Non cash contributions	2013-12-31	$92,395
Value of net income/loss	2013-12-31	$71,838
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$377,760
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$305,922
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$6,987,150
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$5,821,118
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$9,106
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	PARENTEBEARD
Accountancy firm EIN	2013-12-31	232932984
Total unrealized appreciation/depreciation of assets	2013-05-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-05-31	$64,509
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-05-31	$107,492
Total income from all sources (including contributions)	2013-05-31	$15,300,225
Total loss/gain on sale of assets	2013-05-31	$0
Total of all expenses incurred	2013-05-31	$14,980,506
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-05-31	$13,974,717
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-05-31	$15,300,225
Value of total assets at end of year	2013-05-31	$370,431
Value of total assets at beginning of year	2013-05-31	$93,695
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-05-31	$1,005,789
Total interest from all sources	2013-05-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-05-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-05-31	No
Administrative expenses professional fees incurred	2013-05-31	$85,000
Was this plan covered by a fidelity bond	2013-05-31	Yes
Value of fidelity bond cover	2013-05-31	$500,000
If this is an individual account plan, was there a blackout period	2013-05-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-05-31	No
Contributions received from participants	2013-05-31	$2,262,893
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-05-31	$983,394
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-05-31	$362,228
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-05-31	$93,695
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-05-31	$24,928
Administrative expenses (other) incurred	2013-05-31	$101,230
Liabilities. Value of operating payables at end of year	2013-05-31	$64,509
Liabilities. Value of operating payables at beginning of year	2013-05-31	$82,564
Total non interest bearing cash at end of year	2013-05-31	$8,203
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-05-31	No
Income. Non cash contributions	2013-05-31	$101,230
Value of net income/loss	2013-05-31	$319,719
Value of net assets at end of year (total assets less liabilities)	2013-05-31	$305,922
Value of net assets at beginning of year (total assets less liabilities)	2013-05-31	$-13,797
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-05-31	No
Were any leases to which the plan was party in default or uncollectible	2013-05-31	No
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-05-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2013-05-31	$12,991,323
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-05-31	No
Was there a failure to transmit to the plan any participant contributions	2013-05-31	No
Has the plan failed to provide any benefit when due under the plan	2013-05-31	No
Contributions received in cash from employer	2013-05-31	$12,936,102
Contract administrator fees	2013-05-31	$819,559
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-05-31	No
Did the plan have assets held for investment	2013-05-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-05-31	No
Opinion of an independent qualified public accountant for this plan	2013-05-31	Unqualified
Accountancy firm name	2013-05-31	PARENTEBEARD
Accountancy firm EIN	2013-05-31	232932984
2012 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-05-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-05-31	$107,492
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-05-31	$0
Total income from all sources (including contributions)	2012-05-31	$11,680,366
Total loss/gain on sale of assets	2012-05-31	$0
Total of all expenses incurred	2012-05-31	$14,342,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-05-31	$13,179,830
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-05-31	$11,680,366
Value of total assets at end of year	2012-05-31	$93,695
Value of total assets at beginning of year	2012-05-31	$2,648,726
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-05-31	$1,163,059
Total interest from all sources	2012-05-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-05-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-05-31	No
Administrative expenses professional fees incurred	2012-05-31	$97,881
Was this plan covered by a fidelity bond	2012-05-31	Yes
Value of fidelity bond cover	2012-05-31	$500,000
If this is an individual account plan, was there a blackout period	2012-05-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-05-31	No
Contributions received from participants	2012-05-31	$2,693,459
Assets. Other investments not covered elsewhere at beginning of year	2012-05-31	$2,509,500
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-05-31	$1,075,016
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-05-31	$93,695
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-05-31	$106,829
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-05-31	$24,928
Administrative expenses (other) incurred	2012-05-31	$136,448
Liabilities. Value of operating payables at end of year	2012-05-31	$82,564
Total non interest bearing cash at beginning of year	2012-05-31	$32,397
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-05-31	No
Income. Non cash contributions	2012-05-31	$136,448
Value of net income/loss	2012-05-31	$-2,662,523
Value of net assets at end of year (total assets less liabilities)	2012-05-31	$-13,797
Value of net assets at beginning of year (total assets less liabilities)	2012-05-31	$2,648,726
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-05-31	No
Were any leases to which the plan was party in default or uncollectible	2012-05-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2012-05-31	$12,104,814
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-05-31	No
Was there a failure to transmit to the plan any participant contributions	2012-05-31	No
Has the plan failed to provide any benefit when due under the plan	2012-05-31	No
Contributions received in cash from employer	2012-05-31	$8,850,459
Contract administrator fees	2012-05-31	$928,730
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-05-31	No
Did the plan have assets held for investment	2012-05-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-05-31	No
Opinion of an independent qualified public accountant for this plan	2012-05-31	Unqualified
Accountancy firm name	2012-05-31	PARENTEBEARD
Accountancy firm EIN	2012-05-31	232932984
2011 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-05-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-05-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-05-31	$90,423
Total income from all sources (including contributions)	2011-05-31	$16,034,087
Total loss/gain on sale of assets	2011-05-31	$0
Total of all expenses incurred	2011-05-31	$13,361,255
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-05-31	$12,190,200
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-05-31	$16,034,087
Value of total assets at end of year	2011-05-31	$2,648,726
Value of total assets at beginning of year	2011-05-31	$66,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-05-31	$1,171,055
Total interest from all sources	2011-05-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-05-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-05-31	No
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-05-31	$0
Administrative expenses professional fees incurred	2011-05-31	$1,171,055
Was this plan covered by a fidelity bond	2011-05-31	Yes
Value of fidelity bond cover	2011-05-31	$500,000
If this is an individual account plan, was there a blackout period	2011-05-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-05-31	No
Amount of non-exempt transactions with any party-in-interest	2011-05-31	$0
Contributions received from participants	2011-05-31	$2,378,440
Assets. Other investments not covered elsewhere at end of year	2011-05-31	$2,509,500
Assets. Other investments not covered elsewhere at beginning of year	2011-05-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-05-31	$106,829
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-05-31	$66,317
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-05-31	$22,774
Liabilities. Value of operating payables at end of year	2011-05-31	$0
Liabilities. Value of operating payables at beginning of year	2011-05-31	$67,649
Total non interest bearing cash at end of year	2011-05-31	$32,397
Total non interest bearing cash at beginning of year	2011-05-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-05-31	No
Income. Non cash contributions	2011-05-31	$131,152
Value of net income/loss	2011-05-31	$2,672,832
Value of net assets at end of year (total assets less liabilities)	2011-05-31	$2,648,726
Value of net assets at beginning of year (total assets less liabilities)	2011-05-31	$-24,106
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-05-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2011-05-31	$0
Were any leases to which the plan was party in default or uncollectible	2011-05-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2011-05-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-05-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-05-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2011-05-31	$12,190,200
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-05-31	No
Was there a failure to transmit to the plan any participant contributions	2011-05-31	No
Has the plan failed to provide any benefit when due under the plan	2011-05-31	No
Contributions received in cash from employer	2011-05-31	$13,524,495
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-05-31	No
Did the plan have assets held for investment	2011-05-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-05-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-05-31	No
Opinion of an independent qualified public accountant for this plan	2011-05-31	Unqualified
Accountancy firm name	2011-05-31	PARENTBEARD
Accountancy firm EIN	2011-05-31	232932984
2010 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-05-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-05-31	$0
Total unrealized appreciation/depreciation of assets	2010-05-31	$0
Total transfer of assets to this plan	2010-05-31	$0
Total transfer of assets from this plan	2010-05-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-05-31	$90,423
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-05-31	$0
Expenses. Interest paid	2010-05-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2010-05-31	$0
Total income from all sources (including contributions)	2010-05-31	$2,529,274
Total loss/gain on sale of assets	2010-05-31	$0
Total of all expenses incurred	2010-05-31	$4,314,022
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-05-31	$3,910,226
Expenses. Certain deemed distributions of participant loans	2010-05-31	$0
Value of total corrective distributions	2010-05-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-05-31	$2,474,884
Value of total assets at end of year	2010-05-31	$66,317
Value of total assets at beginning of year	2010-05-31	$1,760,642
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-05-31	$403,796
Total income from rents	2010-05-31	$0
Total interest from all sources	2010-05-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-05-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-05-31	No
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2010-05-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2010-05-31	$0
Assets. Real estate other than employer real property at end of year	2010-05-31	$0
Assets. Real estate other than employer real property at beginning of year	2010-05-31	$0
Administrative expenses professional fees incurred	2010-05-31	$403,796
Assets. Corporate prefeered stocks other than exployer securities at end of year	2010-05-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2010-05-31	$0
Was this plan covered by a fidelity bond	2010-05-31	Yes
Value of fidelity bond cover	2010-05-31	$200,000
If this is an individual account plan, was there a blackout period	2010-05-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-05-31	No
Amount of non-exempt transactions with any party-in-interest	2010-05-31	$0
Contributions received from participants	2010-05-31	$494,028
Participant contributions at end of year	2010-05-31	$0
Participant contributions at beginning of year	2010-05-31	$0
Participant contributions at end of year	2010-05-31	$0
Participant contributions at beginning of year	2010-05-31	$0
Assets. Other investments not covered elsewhere at end of year	2010-05-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2010-05-31	$1,746,955
Income. Received or receivable in cash from other sources (including rollovers)	2010-05-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-05-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-05-31	$66,317
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-05-31	$8,088
Assets. Loans (other than to participants) at end of year	2010-05-31	$0
Assets. Loans (other than to participants) at beginning of year	2010-05-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-05-31	$22,774
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-05-31	$0
Other income not declared elsewhere	2010-05-31	$54,390
Administrative expenses (other) incurred	2010-05-31	$0
Liabilities. Value of operating payables at end of year	2010-05-31	$67,649
Liabilities. Value of operating payables at beginning of year	2010-05-31	$0
Total non interest bearing cash at end of year	2010-05-31	$0
Total non interest bearing cash at beginning of year	2010-05-31	$5,599
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-05-31	No
Income. Non cash contributions	2010-05-31	$0
Value of net income/loss	2010-05-31	$-1,784,748
Value of net assets at end of year (total assets less liabilities)	2010-05-31	$-24,106
Value of net assets at beginning of year (total assets less liabilities)	2010-05-31	$1,760,642
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-05-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-05-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2010-05-31	$0
Were any leases to which the plan was party in default or uncollectible	2010-05-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2010-05-31	$0
Assets. partnership/joint venture interests at end of year	2010-05-31	$0
Assets. partnership/joint venture interests at beginning of year	2010-05-31	$0
Investment advisory and management fees	2010-05-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-05-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-05-31	$0
Interest on participant loans	2010-05-31	$0
Income. Interest from loans (other than to participants)	2010-05-31	$0
Interest earned on other investments	2010-05-31	$0
Income. Interest from US Government securities	2010-05-31	$0
Income. Interest from corporate debt instruments	2010-05-31	$0
Value of interest in master investment trust accounts at end of year	2010-05-31	$0
Value of interest in master investment trust accounts at beginning of year	2010-05-31	$0
Value of interest in common/collective trusts at end of year	2010-05-31	$0
Value of interest in common/collective trusts at beginning of year	2010-05-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-05-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-05-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-05-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-05-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2010-05-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2010-05-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-05-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-05-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2010-05-31	$274,052
Asset value of US Government securities at end of year	2010-05-31	$0
Asset value of US Government securities at beginning of year	2010-05-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-05-31	$0
Net investment gain/loss from pooled separate accounts	2010-05-31	$0
Net investment gain or loss from common/collective trusts	2010-05-31	$0
Net gain/loss from 103.12 investment entities	2010-05-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-05-31	No
Was there a failure to transmit to the plan any participant contributions	2010-05-31	No
Has the plan failed to provide any benefit when due under the plan	2010-05-31	No
Assets. Invements in employer securities at end of year	2010-05-31	$0
Assets. Invements in employer securities at beginning of year	2010-05-31	$0
Assets. Value of employer real property at end of year	2010-05-31	$0
Assets. Value of employer real property at beginning of year	2010-05-31	$0
Contributions received in cash from employer	2010-05-31	$1,980,856
Employer contributions (assets) at end of year	2010-05-31	$0
Employer contributions (assets) at beginning of year	2010-05-31	$0
Income. Dividends from preferred stock	2010-05-31	$0
Income. Dividends from common stock	2010-05-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-05-31	$3,636,174
Asset. Corporate debt instrument preferred debt at end of year	2010-05-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2010-05-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2010-05-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2010-05-31	$0
Contract administrator fees	2010-05-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-05-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2010-05-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-05-31	$0
Liabilities. Value of benefit claims payable at end of year	2010-05-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2010-05-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2010-05-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2010-05-31	$0
Did the plan have assets held for investment	2010-05-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-05-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-05-31	No
Aggregate proceeds on sale of assets	2010-05-31	$0
Aggregate carrying amount (costs) on sale of assets	2010-05-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2010-05-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-05-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-05-31	No
Opinion of an independent qualified public accountant for this plan	2010-05-31	Unqualified
Accountancy firm name	2010-05-31	PARENTBEARD, LLC
Accountancy firm EIN	2010-05-31	232932984
2009 : GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2009 401k financial data
Total unrealized appreciation/depreciation of assets	2009-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-12-31	$115,059
Total income from all sources (including contributions)	2009-12-31	$12,662,342
Total loss/gain on sale of assets	2009-12-31	$0
Total of all expenses incurred	2009-12-31	$10,786,641
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2009-12-31	$9,840,744
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2009-12-31	$12,662,342
Value of total assets at end of year	2009-12-31	$1,760,642
Value of total assets at beginning of year	2009-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2009-12-31	$945,897
Total interest from all sources	2009-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2009-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2009-12-31	No
Administrative expenses professional fees incurred	2009-12-31	$945,897
Was this plan covered by a fidelity bond	2009-12-31	Yes
Value of fidelity bond cover	2009-12-31	$200,000
If this is an individual account plan, was there a blackout period	2009-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2009-12-31	No
Contributions received from participants	2009-12-31	$1,014,801
Assets. Other investments not covered elsewhere at end of year	2009-12-31	$1,755,043
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2009-12-31	$9,394,454
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2009-12-31	$32,981
Total non interest bearing cash at end of year	2009-12-31	$5,599
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2009-12-31	No
Value of net income/loss	2009-12-31	$1,875,701
Value of net assets at end of year (total assets less liabilities)	2009-12-31	$1,760,642
Value of net assets at beginning of year (total assets less liabilities)	2009-12-31	$-115,059
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2009-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2009-12-31	No
Were any leases to which the plan was party in default or uncollectible	2009-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2009-12-31	$446,290
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2009-12-31	No
Was there a failure to transmit to the plan any participant contributions	2009-12-31	No
Has the plan failed to provide any benefit when due under the plan	2009-12-31	No
Contributions received in cash from employer	2009-12-31	$11,647,541
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2009-12-31	No
Liabilities. Value of benefit claims payable at beginning of year	2009-12-31	$82,078
Did the plan have assets held for investment	2009-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2009-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2009-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2009-12-31	No
Opinion of an independent qualified public accountant for this plan	2009-12-31	Unqualified
Accountancy firm name	2009-12-31	PARENTEBEARD LLC
Accountancy firm EIN	2009-12-31	232932984

Form 5500 Responses for GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN

2022: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE 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 funding arrangement – Trust	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 - Trust	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE 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 funding arrangement – Trust	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 - Trust	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE 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 funding arrangement – Trust	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 - Trust	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE 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 funding arrangement – Trust	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 - Trust	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE 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 funding arrangement – Trust	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 - Trust	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	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 - Trust	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	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 - Trust	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	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 - Trust	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Submission has been amended	Yes
2013-06-01	This submission is the final filing	No
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan funding arrangement – Trust	Yes
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement - Trust	Yes
2013-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Submission has been amended	Yes
2012-06-01	This submission is the final filing	No
2012-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-06-01	Plan is a collectively bargained plan	No
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan funding arrangement – Trust	Yes
2012-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement - Trust	Yes
2012-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Submission has been amended	Yes
2011-06-01	This submission is the final filing	No
2011-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-06-01	Plan is a collectively bargained plan	No
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan funding arrangement – Trust	Yes
2011-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement - Trust	Yes
2011-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-06-01	Type of plan entity	Single employer plan
2010-06-01	Submission has been amended	Yes
2010-06-01	This submission is the final filing	No
2010-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-06-01	Plan is a collectively bargained plan	No
2010-06-01	Plan funding arrangement – Insurance	Yes
2010-06-01	Plan funding arrangement – Trust	Yes
2010-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-06-01	Plan benefit arrangement – Insurance	Yes
2010-06-01	Plan benefit arrangement - Trust	Yes
2010-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GLENN O. HAWBAKER, INC. EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	926713
Policy instance	1
Insurance contract or identification number 926713 Number of Individuals Covered 984 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 $26,767 Welfare Benefit Premiums Paid to Carrier USD $1,631,938 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 26767 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583066
Policy instance	5
Insurance contract or identification number 583066 Number of Individuals Covered 197 Insurance policy start date 2021-06-01 Insurance policy end date 2022-06-01 Total amount of commissions paid to insurance broker USD $5,388 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided LONG TERM CARE Welfare Benefit Premiums Paid to Carrier USD $71,991 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,388 Insurance broker organization code? 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0236984
Policy instance	2
Insurance contract or identification number 0236984 Number of Individuals Covered 1804 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 $152 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $495,694 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 89 Additional information about fees paid to insurance broker NON-MONETARY COMPENSATION Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10128831001
Policy instance	3
Insurance contract or identification number 10128831001 Number of Individuals Covered 2034 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 Welfare Benefit Premiums Paid to Carrier USD $119,812 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	163392
Policy instance	4
Insurance contract or identification number 163392 Number of Individuals Covered 1806 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 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10128831001
Policy instance	3
Insurance contract or identification number 10128831001 Number of Individuals Covered 2024 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 Welfare Benefit Premiums Paid to Carrier USD $119,957 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583066
Policy instance	5
Insurance contract or identification number 583066 Number of Individuals Covered 234 Insurance policy start date 2020-06-01 Insurance policy end date 2021-06-01 Total amount of commissions paid to insurance broker USD $5,574 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided LONG TERM CARE Welfare Benefit Premiums Paid to Carrier USD $73,985 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,574 Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	163392
Policy instance	4
Insurance contract or identification number 163392 Number of Individuals Covered 2088 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 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	870104
Policy instance	2
Insurance contract or identification number 870104 Number of Individuals Covered 1858 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 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $446,579 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	926713
Policy instance	1
Insurance contract or identification number 926713 Number of Individuals Covered 1110 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 $28,907 Welfare Benefit Premiums Paid to Carrier USD $1,454,460 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 28907 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583066
Policy instance	5
Insurance contract or identification number 583066 Number of Individuals Covered 255 Insurance policy start date 2019-06-01 Insurance policy end date 2020-06-01 Total amount of commissions paid to insurance broker USD $5,730 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided LONG TERM CARE Welfare Benefit Premiums Paid to Carrier USD $77,298 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,730 Insurance broker organization code? 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number	163392
Policy instance	4
Insurance contract or identification number 163392 Number of Individuals Covered 2479 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 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	926713
Policy instance	1
Insurance contract or identification number 926713 Number of Individuals Covered 1107 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 $29,559 Welfare Benefit Premiums Paid to Carrier USD $1,595,748 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 29559 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	870104
Policy instance	2
Insurance contract or identification number 870104 Number of Individuals Covered 1889 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 $750 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $412,476 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 750 Additional information about fees paid to insurance broker 2019 PPP SPECIALTY RETENTION RISK Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10128831001
Policy instance	3
Insurance contract or identification number 10128831001 Number of Individuals Covered 2361 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 Welfare Benefit Premiums Paid to Carrier USD $151,815 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	870104
Policy instance	3
Insurance contract or identification number 870104 Number of Individuals Covered 2214 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 $98 Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $471,048 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $0 Amount paid for insurance broker fees 98 Additional information about fees paid to insurance broker INDIRECT COMPENSATION Insurance broker organization code? 3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	926713
Policy instance	2
Insurance contract or identification number 926713 Number of Individuals Covered 1284 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 $66,354 Welfare Benefit Premiums Paid to Carrier USD $1,482,238 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 66354 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583066
Policy instance	1
Insurance contract or identification number 583066 Number of Individuals Covered 260 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $6,173 Total amount of fees paid to insurance company USD $0 Other welfare benefits provided LONG TERM CARE Welfare Benefit Premiums Paid to Carrier USD $83,794 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,173 Amount paid for insurance broker fees 0 Insurance broker organization code? 3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	10128831001
Policy instance	4
Insurance contract or identification number 10128831001 Number of Individuals Covered 2716 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 Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Welfare Benefit Premiums Paid to Carrier USD $151,144 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	163392
Policy instance	5
Insurance contract or identification number 163392 Number of Individuals Covered 2459 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 Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	210569/583065
Policy instance	3
Insurance contract or identification number 210569/583065 Number of Individuals Covered 1244 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $5,418 Total amount of fees paid to insurance company USD $2,022 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $488,911 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $5,418 Insurance broker organization code? 3 Amount paid for insurance broker fees 2022 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker name GALLAGHER BENEFIT SERVICES, INC.
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	9474
Policy instance	1
Insurance contract or identification number 9474 Number of Individuals Covered 1683 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 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $441,596 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35599 )
Policy contract number	4026110010SSLS
Policy instance	5
Insurance contract or identification number 4026110010SSLS Number of Individuals Covered 1202 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 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $578,732 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	4
Insurance contract or identification number 1368 Number of Individuals Covered 1241 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $1,820 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $36,399 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,820 Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES, INC.
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	109506
Policy instance	2
Insurance contract or identification number 109506 Number of Individuals Covered 2461 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 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $135,185 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	6
Insurance contract or identification number 1368 Number of Individuals Covered 1223 Insurance policy start date 2015-10-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $448 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $8,968 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $448 Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES, INC.
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	9474
Policy instance	1
Insurance contract or identification number 9474 Number of Individuals Covered 1555 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $467,001 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	3
Insurance contract or identification number 583065 Number of Individuals Covered 1246 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $11,432 Total amount of fees paid to insurance company USD $2,950 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $614,528 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,080 Amount paid for insurance broker fees -1427 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFITS SERVICES, INC.
HIGHMARK CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35599 )
Policy contract number	4026110010SSLS
Policy instance	5
Insurance contract or identification number 4026110010SSLS Number of Individuals Covered 1238 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $327,085 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	109506
Policy instance	2
Insurance contract or identification number 109506 Number of Individuals Covered 2563 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $137,528 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	4
Insurance contract or identification number 1368 Number of Individuals Covered 1223 Insurance policy start date 2014-10-01 Insurance policy end date 2015-09-30 Total amount of commissions paid to insurance broker USD $1,794 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM. Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $35,871 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,794 Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES, INC.
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	5
Insurance contract or identification number 1368 Number of Individuals Covered 1193 Insurance policy start date 2013-10-01 Insurance policy end date 2014-09-30 Total amount of commissions paid to insurance broker USD $1,682 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM. Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $33,643 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,682 Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	4
Insurance contract or identification number 583065 Number of Individuals Covered 1191 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $33,541 Total amount of fees paid to insurance company USD $6,158 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $427,755 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $32,265 Amount paid for insurance broker fees 1913 Additional information about fees paid to insurance broker ADDITIONAL COMPENSATION Insurance broker organization code? 3 Insurance broker name AGIS NETWORK, INC.
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	9474
Policy instance	2
Insurance contract or identification number 9474 Number of Individuals Covered 1726 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $422,664 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	109506
Policy instance	3
Insurance contract or identification number 109506 Number of Individuals Covered 2514 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $125,492 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 35599 )
Policy contract number	4026110010SSLS
Policy instance	1
Insurance contract or identification number 4026110010SSLS Number of Individuals Covered 1199 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $395,962 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	4
Insurance contract or identification number 1368 Number of Individuals Covered 1310 Insurance policy start date 2012-10-01 Insurance policy end date 2013-09-30 Total amount of commissions paid to insurance broker USD $1,829 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $36,575 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,829 Insurance broker organization code? 3 Insurance broker name LONGFELLOW FINANCIAL
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	210569
Policy instance	2
Insurance contract or identification number 210569 Number of Individuals Covered 1176 Insurance policy start date 2013-06-01 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 $291 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $23,276 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	PA9474
Policy instance	3
Insurance contract or identification number PA9474 Number of Individuals Covered 1578 Insurance policy start date 2013-06-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $8,698 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $289,933 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	02532665
Policy instance	4
Insurance contract or identification number 02532665 Number of Individuals Covered 1186 Insurance policy start date 2013-06-01 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $132,310 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583066
Policy instance	5
Insurance contract or identification number 583066 Number of Individuals Covered 210 Insurance policy start date 2013-06-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $3,426 Total amount of fees paid to insurance company USD $286 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $22,717 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	3
Insurance contract or identification number 583065 Number of Individuals Covered 1176 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $20,916 Total amount of fees paid to insurance company USD $2,804 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $224,156 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,916 Amount paid for insurance broker fees 2804 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3 Insurance broker name GALLAGHER BENEFIT SERVICES, INC.
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	PA9474
Policy instance	1
Insurance contract or identification number PA9474 Number of Individuals Covered 1578 Insurance policy start date 2013-06-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $8,698 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $289,933 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,698 Insurance broker organization code? 3 Insurance broker name LONGFELLOW BENEFITS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	2532665
Policy instance	2
Insurance contract or identification number 2532665 Number of Individuals Covered 1186 Insurance policy start date 2013-06-01 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 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $132,310 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	1
Insurance contract or identification number 583065 Number of Individuals Covered 1081 Insurance policy start date 2013-06-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $17,490 Total amount of fees paid to insurance company USD $2,227 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $178,163 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	210569
Policy instance	2
Insurance contract or identification number 210569 Number of Individuals Covered 1159 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $536 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $42,849 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	1
Insurance contract or identification number 583065 Number of Individuals Covered 1214 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $42,964 Total amount of fees paid to insurance company USD $5,770 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $306,828 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	3
Insurance contract or identification number 583065 Number of Individuals Covered 1214 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $48,449 Total amount of fees paid to insurance company USD $6,763 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $386,246 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $35,596 Amount paid for insurance broker fees 4828 Additional information about fees paid to insurance broker OTHER COMPENSATION Insurance broker organization code? 3 Insurance broker name HENDERSON BROTHERS
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	2532665
Policy instance	2
Insurance contract or identification number 2532665 Number of Individuals Covered 1218 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $134,708 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	PA9474
Policy instance	1
Insurance contract or identification number PA9474 Number of Individuals Covered 1994 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $13,159 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $438,635 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,159 Insurance broker organization code? 3 Insurance broker name LONGFELLOW BENEFITS
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	4
Insurance contract or identification number 1368 Number of Individuals Covered 1475 Insurance policy start date 2011-10-01 Insurance policy end date 2012-09-30 Total amount of commissions paid to insurance broker USD $2,038 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $40,769 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $2,038 Insurance broker organization code? 3 Insurance broker name MID-STATE OCCUPATIONAL HEALTH
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583066
Policy instance	5
Insurance contract or identification number 583066 Number of Individuals Covered 212 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $5,485 Total amount of fees paid to insurance company USD $457 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $36,569 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	02532665
Policy instance	4
Insurance contract or identification number 02532665 Number of Individuals Covered 1218 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $134,708 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	PA9474
Policy instance	3
Insurance contract or identification number PA9474 Number of Individuals Covered 1994 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 Total amount of commissions paid to insurance broker USD $13,159 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $438,635 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	3
Insurance contract or identification number 583065 Number of Individuals Covered 1251 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 Total amount of commissions paid to insurance broker USD $40,614 Total amount of fees paid to insurance company USD $5,961 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $433,634 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	4
Insurance contract or identification number 1368 Number of Individuals Covered 1368 Insurance policy start date 2010-10-01 Insurance policy end date 2011-09-30 Total amount of commissions paid to insurance broker USD $1,802 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $36,047 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	2532665
Policy instance	2
Insurance contract or identification number 2532665 Number of Individuals Covered 2867 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $147,410 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	PA9474
Policy instance	1
Insurance contract or identification number PA9474 Number of Individuals Covered 2186 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 Total amount of commissions paid to insurance broker USD $14,485 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $483,560 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	2532665
Policy instance	2
Insurance contract or identification number 2532665 Number of Individuals Covered 2822 Insurance policy start date 2010-06-01 Insurance policy end date 2011-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $129,342 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065
Policy instance	3
Insurance contract or identification number 583065 Number of Individuals Covered 1435 Insurance policy start date 2010-06-01 Insurance policy end date 2011-05-31 Total amount of commissions paid to insurance broker USD $34,581 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided ACCIDENTAL DEATH AND DISMEMBERMENT LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $396,897 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $34,581 Insurance broker organization code? 3 Insurance broker name HENDERSON BROTHERS, INC.
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	PA9474
Policy instance	1
Insurance contract or identification number PA9474 Number of Individuals Covered 2072 Insurance policy start date 2010-06-01 Insurance policy end date 2011-05-31 Total amount of commissions paid to insurance broker USD $13,921 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $459,056 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13,921 Insurance broker organization code? 3 Insurance broker name HENDERSON BROTHERS
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	4
Insurance contract or identification number 1368 Number of Individuals Covered 1174 Insurance policy start date 2009-10-01 Insurance policy end date 2010-09-30 Total amount of commissions paid to insurance broker USD $1,475 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $29,491 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Commission paid to Insurance Broker USD $1,475 Insurance broker organization code? 3 Insurance broker name MIS-STATE OCCUPATIONAL HEALTH
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number	PA9474
Policy instance	4
Insurance contract or identification number PA9474 Number of Individuals Covered 1099 Insurance policy start date 2010-01-01 Insurance policy end date 2010-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	3
Insurance contract or identification number 1368 Number of Individuals Covered 1363 Insurance policy start date 2009-10-01 Insurance policy end date 2010-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number	2532665
Policy instance	2
Insurance contract or identification number 2532665 Number of Individuals Covered 2407 Insurance policy start date 2010-01-01 Insurance policy end date 2010-05-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit Yes Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $42,259 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	210569 583065-6
Policy instance	1
Insurance contract or identification number 210569 583065-6 Number of Individuals Covered 1363 Insurance policy start date 2010-01-01 Insurance policy end date 2010-05-31 Total amount of commissions paid to insurance broker USD $10,981 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $159,112 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $10,981 Insurance broker organization code? 3 Insurance broker name HENDERSON BROTHERS, INC.
HARLEYSVILLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64327 )
Policy contract number	G-4103
Policy instance	1
Insurance contract or identification number G-4103 Number of Individuals Covered 0 Insurance policy start date 2009-01-01 Insurance policy end date 2009-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $3,052 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $3,052 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 3052 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name HENDERSON BROTHERS, INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number	583065/583066
Policy instance	2
Insurance contract or identification number 583065/583066 Number of Individuals Covered 1170 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $85,572 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Long Term Disability Insurance Welfare Benefit Yes Unemployment Insurance Welfare Benefit No Other welfare benefits provided LONG TERM CARE Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $387,898 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 85572 Additional information about fees paid to insurance broker FEES Insurance broker organization code? 3 Insurance broker name HENDERSON BROTHERS, INC.
ESI (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number	1368
Policy instance	3
Insurance contract or identification number 1368 Number of Individuals Covered 1253 Insurance policy start date 2008-10-01 Insurance policy end date 2009-09-30 Total amount of commissions paid to insurance broker USD $1,500 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided EMPLOYEE ASSISTANCE PROGRAM Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $30,009 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,500 Insurance broker organization code? 3 Insurance broker name MID-STATE OCCUPATIONAL HEALTH