401k Plan data: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN plan

BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN
Plan identification number	501

BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC has sponsored the creation of one or more 401k plans.

Company Name: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC

Employer identification number (EIN): 263860108

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Additional information about BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2008-12-15

Company Identification Number: 0801063046

Legal Registered Office Address: 2800 NORTH LOOP W STE 1100

HOUSTON
United States of Amercica (USA)
77092

More information about BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-07-01 PETER SULLIVAN 2023-04-14 LARRY KARREN 2023-04-14
501 2020-07-01 PETER SULLIVAN 2022-04-11 LARRY KARREN 2022-04-11
501 2019-07-01 PETER SULLIVAN 2021-04-06 LARRY KARREN 2021-04-06
501 2018-07-01 PETER SULLIVAN 2020-03-13 LARRY KARREN 2020-03-13
501 2017-07-01
501 2016-07-01
501 2015-07-01
501 2014-07-01 PETER SULLIVAN
501 2013-07-01 MILLICENT ERWIN, CPA
501 2012-07-01 MILLICENT ERWIN, CPA MILLICENT ERWIN, CPA 2014-01-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-07-01	PETER SULLIVAN	2023-04-14	LARRY KARREN	2023-04-14
501	2020-07-01	PETER SULLIVAN	2022-04-11	LARRY KARREN	2022-04-11
501	2019-07-01	PETER SULLIVAN	2021-04-06	LARRY KARREN	2021-04-06
501	2018-07-01	PETER SULLIVAN	2020-03-13	LARRY KARREN	2020-03-13
501	2017-07-01
501	2016-07-01
501	2015-07-01
501	2014-07-01	PETER SULLIVAN
501	2013-07-01	MILLICENT ERWIN, CPA
501	2012-07-01	MILLICENT ERWIN, CPA		MILLICENT ERWIN, CPA	2014-01-20

Plan Statistics for BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN

401k plan membership statisitcs for BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN

Measure Date Value
2021: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 164
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 215
Total of all active and inactive participants 2021-07-01 215
2020: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 181
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 164
Total of all active and inactive participants 2020-07-01 164
2019: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 182
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 181
Total of all active and inactive participants 2019-07-01 181
2018: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 193
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 182
Total of all active and inactive participants 2018-07-01 182
2017: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 217
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 193
Total of all active and inactive participants 2017-07-01 193
2016: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 226
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 217
Total of all active and inactive participants 2016-07-01 217
2015: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 234
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 226
Total of all active and inactive participants 2015-07-01 226
2014: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 227
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 234
Total of all active and inactive participants 2014-07-01 234
2013: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 278
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 227
Total of all active and inactive participants 2013-07-01 227
Total participants 2013-07-01 227
2012: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 247
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 278
Total of all active and inactive participants 2012-07-01 278
Total participants 2012-07-01 278

Measure	Date	Value
2021: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	164
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	215
Total of all active and inactive participants	2021-07-01	215
2020: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	181
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	164
Total of all active and inactive participants	2020-07-01	164
2019: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	182
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	181
Total of all active and inactive participants	2019-07-01	181
2018: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	193
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	182
Total of all active and inactive participants	2018-07-01	182
2017: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	217
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	193
Total of all active and inactive participants	2017-07-01	193
2016: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	226
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	217
Total of all active and inactive participants	2016-07-01	217
2015: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	234
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	226
Total of all active and inactive participants	2015-07-01	226
2014: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	227
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	234
Total of all active and inactive participants	2014-07-01	234
2013: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	278
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	227
Total of all active and inactive participants	2013-07-01	227
Total participants	2013-07-01	227
2012: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	247
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	278
Total of all active and inactive participants	2012-07-01	278
Total participants	2012-07-01	278

Form 5500 Responses for BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN

2021: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC EMPLOYEE HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

565682

Policy instance

Insurance contract or identification number	565682
Number of Individuals Covered	62
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $9,121
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GLTC, GIL
Welfare Benefit Premiums Paid to Carrier	USD $56,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,121

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	215
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,752
Total amount of fees paid to insurance company	USD $1,351
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,752
Amount paid for insurance broker fees	1351
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000028788

Policy instance

Insurance contract or identification number	000000028788
Number of Individuals Covered	211
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $38,130
Total amount of fees paid to insurance company	USD $1,216
Other welfare benefits provided	LTD, ADD, LIFE
Welfare Benefit Premiums Paid to Carrier	USD $250,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,152
Insurance broker organization code?	3
Amount paid for insurance broker fees	1216
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000028790

Policy instance

Insurance contract or identification number	000000028790
Number of Individuals Covered	19
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $1,132
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LTC
Welfare Benefit Premiums Paid to Carrier	USD $6,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,132

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161532

Policy instance

Insurance contract or identification number	0000161532
Number of Individuals Covered	21
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $10,077
Total amount of fees paid to insurance company	USD $6,178
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,031
Amount paid for insurance broker fees	763
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161533

Policy instance

Insurance contract or identification number	0000161533
Number of Individuals Covered	8
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $1,473
Total amount of fees paid to insurance company	USD $865
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $993
Amount paid for insurance broker fees	192
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161534

Policy instance

Insurance contract or identification number	0000161534
Number of Individuals Covered	35
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $7,411
Total amount of fees paid to insurance company	USD $4,224
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,916
Amount paid for insurance broker fees	919
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000209721

Policy instance

Insurance contract or identification number	000000209721
Number of Individuals Covered	92
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-07
Total amount of commissions paid to insurance broker	USD $10,033
Total amount of fees paid to insurance company	USD $267
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,033
Amount paid for insurance broker fees	267
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

0000513315

Policy instance

Insurance contract or identification number	0000513315
Number of Individuals Covered	7
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $36
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0594721

Policy instance

Insurance contract or identification number	R0594721
Number of Individuals Covered	73
Insurance policy start date	2021-07-01
Insurance policy end date	2022-07-01
Total amount of commissions paid to insurance broker	USD $1,475
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GCIEE, GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $18,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,469

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161533

Policy instance

Insurance contract or identification number	0000161533
Number of Individuals Covered	8
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $2,147
Total amount of fees paid to insurance company	USD $715
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,416
Amount paid for insurance broker fees	234
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161532

Policy instance

Insurance contract or identification number	0000161532
Number of Individuals Covered	21
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $78,033
Total amount of fees paid to insurance company	USD $3,317
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58,525
Amount paid for insurance broker fees	981
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000028790

Policy instance

Insurance contract or identification number	000000028790
Number of Individuals Covered	6
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $954
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LTC
Welfare Benefit Premiums Paid to Carrier	USD $6,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $898
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000028788

Policy instance

Insurance contract or identification number	000000028788
Number of Individuals Covered	205
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $37,949
Total amount of fees paid to insurance company	USD $836
Other welfare benefits provided	LTD, ADD, LIFE
Welfare Benefit Premiums Paid to Carrier	USD $267,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,026
Insurance broker organization code?	3
Amount paid for insurance broker fees	836
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	208
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $794
Total amount of fees paid to insurance company	USD $907
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $794
Amount paid for insurance broker fees	907
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161534

Policy instance

Insurance contract or identification number	0000161534
Number of Individuals Covered	36
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $8,181
Total amount of fees paid to insurance company	USD $2,059
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,330
Amount paid for insurance broker fees	922
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000209721

Policy instance

Insurance contract or identification number	000000209721
Number of Individuals Covered	95
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-07
Total amount of commissions paid to insurance broker	USD $9,335
Total amount of fees paid to insurance company	USD $182
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,335
Amount paid for insurance broker fees	182
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

0000513315

Policy instance

Insurance contract or identification number	0000513315
Number of Individuals Covered	7
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $32
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,331
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

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

GERHA163

Policy instance

Insurance contract or identification number	GERHA163
Number of Individuals Covered	163
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $588,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCCLOT41186

Policy instance

Insurance contract or identification number	HCCLOT41186
Number of Individuals Covered	163
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $3,009
Total amount of fees paid to insurance company	USD $1,082
Other welfare benefits provided	TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $30,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,009
Amount paid for insurance broker fees	1082
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0594721

Policy instance

Insurance contract or identification number	R0594721
Number of Individuals Covered	83
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $2,219
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GCIEE, GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $28,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,701
Insurance broker organization code?	3

WEX HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

Policy instance

Number of Individuals Covered	48
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $9,143
Other welfare benefits provided	FSA
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9143

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	216
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,287
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,305
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	2287
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

565682

Policy instance

Insurance contract or identification number	565682
Number of Individuals Covered	80
Insurance policy start date	2019-07-01
Insurance policy end date	2020-07-01
Total amount of commissions paid to insurance broker	USD $10,344
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $68,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,344
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0594721

Policy instance

Insurance contract or identification number	R0594721
Number of Individuals Covered	86
Insurance policy start date	2019-07-01
Insurance policy end date	2020-07-01
Total amount of commissions paid to insurance broker	USD $2,393
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GCIEE, GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $22,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,402
Insurance broker organization code?	3

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

Policy contract number

00622566

Policy instance

Insurance contract or identification number	00622566
Number of Individuals Covered	262
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $-603
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,622,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	-603
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

565682

Policy instance

Insurance contract or identification number	565682
Number of Individuals Covered	80
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $10,570
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $70,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,570
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

0000513315

Policy instance

Insurance contract or identification number	0000513315
Number of Individuals Covered	9
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $70
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

209721

Policy instance

Insurance contract or identification number	209721
Number of Individuals Covered	74
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $8,347
Total amount of fees paid to insurance company	USD $418
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,347
Amount paid for insurance broker fees	418
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	167
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $35,163
Total amount of fees paid to insurance company	USD $1,872
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $252,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,280
Insurance broker organization code?	3
Amount paid for insurance broker fees	1872
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161534

Policy instance

Insurance contract or identification number	0000161534
Number of Individuals Covered	30
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $7,524
Total amount of fees paid to insurance company	USD $2,645
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,838
Amount paid for insurance broker fees	748
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0594721

Policy instance

Insurance contract or identification number	R0594721
Number of Individuals Covered	101
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $2,252
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GCIEE, GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $23,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,642
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028790

Policy instance

Insurance contract or identification number	028790
Number of Individuals Covered	20
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $1,066
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LTC
Welfare Benefit Premiums Paid to Carrier	USD $7,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,066
Insurance broker organization code?	3

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

Policy contract number

00622566

Policy instance

Insurance contract or identification number	00622566
Number of Individuals Covered	261
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,092
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,002,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1092
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161532

Policy instance

Insurance contract or identification number	0000161532
Number of Individuals Covered	17
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $7,332
Total amount of fees paid to insurance company	USD $2,309
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,680
Amount paid for insurance broker fees	697
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	219
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,313
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	2313
Insurance broker organization code?	3

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161533

Policy instance

Insurance contract or identification number	0000161533
Number of Individuals Covered	5
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $2,000
Total amount of fees paid to insurance company	USD $581
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,317
Amount paid for insurance broker fees	188
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028790

Policy instance

Insurance contract or identification number	028790
Number of Individuals Covered	15
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $573
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LTC
Welfare Benefit Premiums Paid to Carrier	USD $4,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	227
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $49
Total amount of fees paid to insurance company	USD $2,276
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,008
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

565682

Policy instance

Insurance contract or identification number	565682
Number of Individuals Covered	13
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $6,397
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $44,463
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

0000513315

Policy instance

Insurance contract or identification number	0000513315
Number of Individuals Covered	11
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $77
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,834
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

209721

Policy instance

Insurance contract or identification number	209721
Number of Individuals Covered	75
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $8,107
Total amount of fees paid to insurance company	USD $406
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,073
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

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	165
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $34,974
Total amount of fees paid to insurance company	USD $1,863
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $247,600
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

166267

Policy instance

Insurance contract or identification number	166267
Number of Individuals Covered	375
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $14
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,773,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0000161534

Policy instance

Insurance contract or identification number	0000161534
Number of Individuals Covered	26
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $5,084
Total amount of fees paid to insurance company	USD $1,838
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,421
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

R0594721

Policy instance

Insurance contract or identification number	R0594721
Number of Individuals Covered	109
Insurance policy start date	2017-07-01
Insurance policy end date	2018-07-01
Total amount of commissions paid to insurance broker	USD $3,642
Total amount of fees paid to insurance company	USD $44
Other welfare benefits provided	GCIEE, GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $33,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	233
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $2,118
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,118
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

565682

Policy instance

Insurance contract or identification number	565682
Number of Individuals Covered	56
Insurance policy start date	2015-07-01
Insurance policy end date	2016-07-01
Total amount of commissions paid to insurance broker	USD $6,570
Total amount of fees paid to insurance company	USD $152
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $43,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,570
Amount paid for insurance broker fees	152
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

0000513315

Policy instance

Insurance contract or identification number	0000513315
Number of Individuals Covered	12
Insurance policy start date	2015-07-01
Insurance policy end date	2016-07-01
Total amount of commissions paid to insurance broker	USD $71
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $71
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

209721

Policy instance

Insurance contract or identification number	209721
Number of Individuals Covered	133
Insurance policy start date	2015-07-01
Insurance policy end date	2016-07-01
Total amount of commissions paid to insurance broker	USD $10,373
Total amount of fees paid to insurance company	USD $519
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,373
Amount paid for insurance broker fees	519
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	226
Insurance policy start date	2015-07-01
Insurance policy end date	2016-07-01
Total amount of commissions paid to insurance broker	USD $31,451
Total amount of fees paid to insurance company	USD $1,709
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $227,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,602
Insurance broker organization code?	3
Amount paid for insurance broker fees	1709
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

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

Policy contract number

166267

Policy instance

Insurance contract or identification number	166267
Number of Individuals Covered	423
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $45
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,916,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	39
Additional information about fees paid to insurance broker	MISCELLANEOUS
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE ,

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	234
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $2,491
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,491
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

565682

Policy instance

Insurance contract or identification number	565682
Number of Individuals Covered	18
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $6,660
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $43,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,505
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

586343

Policy instance

Insurance contract or identification number	586343
Number of Individuals Covered	231
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,178
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,237,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,178
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

0000513315

Policy instance

Insurance contract or identification number	0000513315
Number of Individuals Covered	12
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $125
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $125
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE, DESCANT & BRITT

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

209721

Policy instance

Insurance contract or identification number	209721
Number of Individuals Covered	114
Insurance policy start date	2014-09-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $8,586
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,586
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	234
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $53,397
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $347,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,228
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

209721

Policy instance

Insurance contract or identification number	209721
Number of Individuals Covered	114
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $10,506
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,254
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	227
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,647
Total amount of fees paid to insurance company	USD $1,126
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,647
Amount paid for insurance broker fees	1126
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

565682

Policy instance

Insurance contract or identification number	565682
Number of Individuals Covered	68
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $6,534
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	GROUP LTC, GROUP INDIV LTC
Welfare Benefit Premiums Paid to Carrier	USD $43,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,534
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INC

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

586343

Policy instance

Insurance contract or identification number	586343
Number of Individuals Covered	221
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $3,106
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,139,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,106
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

0000513315

Policy instance

Insurance contract or identification number	0000513315
Number of Individuals Covered	13
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $134
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $134
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

209721

Policy instance

Insurance contract or identification number	209721
Number of Individuals Covered	108
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $10,553
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,553
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	221
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $41,860
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $274,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,070
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	173
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $31,678
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $206,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,753
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	234
Insurance policy start date	2011-09-01
Insurance policy end date	2012-09-01
Total amount of commissions paid to insurance broker	USD $563
Total amount of fees paid to insurance company	USD $275
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $563
Amount paid for insurance broker fees	275
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	166
Insurance policy start date	2012-06-01
Insurance policy end date	2013-06-01
Total amount of commissions paid to insurance broker	USD $29,977
Total amount of fees paid to insurance company	USD $668
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,977
Insurance broker organization code?	3
Amount paid for insurance broker fees	668
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

586343

Policy instance

Insurance contract or identification number	586343
Number of Individuals Covered	213
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $112,830
Total amount of fees paid to insurance company	USD $5,923
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,246,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $112,830
Amount paid for insurance broker fees	5923
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

209721

Policy instance

Insurance contract or identification number	209721
Number of Individuals Covered	124
Insurance policy start date	2011-09-01
Insurance policy end date	2012-09-01
Total amount of commissions paid to insurance broker	USD $10,699
Total amount of fees paid to insurance company	USD $1,716
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,699
Amount paid for insurance broker fees	1716
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

511315

Policy instance

Insurance contract or identification number	511315
Number of Individuals Covered	13
Insurance policy start date	2012-06-01
Insurance policy end date	2013-06-01
Total amount of commissions paid to insurance broker	USD $146
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $146
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE, DESCANT & BRITT

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

028788

Policy instance

Insurance contract or identification number	028788
Number of Individuals Covered	278
Insurance policy start date	2011-09-01
Insurance policy end date	2012-09-01
Total amount of commissions paid to insurance broker	USD $3,646
Total amount of fees paid to insurance company	USD $1,871
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,646
Amount paid for insurance broker fees	1871
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

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

Policy contract number

00368967

Policy instance

Insurance contract or identification number	00368967
Number of Individuals Covered	223
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31
Total amount of commissions paid to insurance broker	USD $2,800
Total amount of fees paid to insurance company	USD $1,224
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,800
Amount paid for insurance broker fees	1224
Insurance broker organization code?	3
Insurance broker name	BOWEN, MICLETTE & BRITT INSURANCE A

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Company Name:	BOWEN, MICLETTE & BRITT INSURANCE AGENCY, LLC
Employer identification number (EIN):	263860108
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2008-12-15
Company Identification Number:	0801063046
Legal Registered Office Address:	2800 NORTH LOOP W STE 1100 HOUSTON United States of Amercica (USA) 77092