401k Plan data: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN plan

CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN
Plan identification number	501

CASTRUCCI AUTO DEALERS 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 Other welfare benefit cover

401k Sponsoring company profile

MATT CASTRUCCI, INC. has sponsored the creation of one or more 401k plans.

Company Name: MATT CASTRUCCI, INC.

Employer identification number (EIN): 310871089

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 BOB THAMANN 2023-12-11
501 2021-07-01 BOB THAMANN 2022-12-20
501 2020-07-01 BOB THAMANN 2021-12-15
501 2019-07-01 BOB THAMANN 2020-11-30
501 2018-07-01 PATRICIA FRASER 2019-11-21
501 2017-07-01
501 2016-07-01
501 2015-07-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-07-01	BOB THAMANN	2023-12-11
501	2021-07-01	BOB THAMANN	2022-12-20
501	2020-07-01	BOB THAMANN	2021-12-15
501	2019-07-01	BOB THAMANN	2020-11-30
501	2018-07-01	PATRICIA FRASER	2019-11-21
501	2017-07-01
501	2016-07-01
501	2015-07-01

Plan Statistics for CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN

401k plan membership statisitcs for CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN

Measure Date Value
2022: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 202
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 233
Total of all active and inactive participants 2022-07-01 233
2021: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 198
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 201
Number of retired or separated participants receiving benefits 2021-07-01 1
Total of all active and inactive participants 2021-07-01 202
2020: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 204
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 198
Total of all active and inactive participants 2020-07-01 198
2019: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 226
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 201
Number of retired or separated participants receiving benefits 2019-07-01 3
Total of all active and inactive participants 2019-07-01 204
2018: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 2018-07-01 226
Total of all active and inactive participants 2018-07-01 226
2017: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 212
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
Total participants 2017-07-01 193
2016: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 2016-07-01 212
Total of all active and inactive participants 2016-07-01 212
Total participants 2016-07-01 212
2015: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 2015-07-01 220
Total of all active and inactive participants 2015-07-01 220
Total participants 2015-07-01 220

Measure	Date	Value
2022: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	202
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	233
Total of all active and inactive participants	2022-07-01	233
2021: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	198
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	201
Number of retired or separated participants receiving benefits	2021-07-01	1
Total of all active and inactive participants	2021-07-01	202
2020: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	204
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	198
Total of all active and inactive participants	2020-07-01	198
2019: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	226
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	201
Number of retired or separated participants receiving benefits	2019-07-01	3
Total of all active and inactive participants	2019-07-01	204
2018: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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	226
Total of all active and inactive participants	2018-07-01	226
2017: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	212
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
Total participants	2017-07-01	193
2016: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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	212
Total of all active and inactive participants	2016-07-01	212
Total participants	2016-07-01	212
2015: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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	220
Total of all active and inactive participants	2015-07-01	220
Total participants	2015-07-01	220

Form 5500 Responses for CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN

2022: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 benefit arrangement – Insurance	Yes
2020: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 benefit arrangement – Insurance	Yes
2019: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 benefit arrangement – Insurance	Yes
2018: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 benefit arrangement – Insurance	Yes
2017: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 benefit arrangement – Insurance	Yes
2016: CASTRUCCI AUTO DEALERS WELFARE BENEFIT 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 benefit arrangement – Insurance	Yes
2015: CASTRUCCI AUTO DEALERS WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	First time form 5500 has been submitted	Yes
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ714

Policy instance

Insurance contract or identification number	WJ714
Number of Individuals Covered	13
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,436
Other welfare benefits provided	STD, HOSPITAL, PERSONAL TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $14,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $498
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WN474

Policy instance

Insurance contract or identification number	WN474
Number of Individuals Covered	11
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $836
Other welfare benefits provided	ACCIDENT,HOSPITAL,LIFE,STD,CANCER
Welfare Benefit Premiums Paid to Carrier	USD $7,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $200
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WT871

Policy instance

Insurance contract or identification number	WT871
Number of Individuals Covered	9
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,148
Total amount of fees paid to insurance company	USD $9
Other welfare benefits provided	ACCIDENT, CANCER, SICKNESS
Welfare Benefit Premiums Paid to Carrier	USD $9,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $507
Insurance broker organization code?	3
Amount paid for insurance broker fees	9
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ683

Policy instance

Insurance contract or identification number	WJ683
Number of Individuals Covered	17
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,188
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $19,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $455
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41125

Policy instance

Insurance contract or identification number	41125
Number of Individuals Covered	233
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $716
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $7,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $716
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009693

Policy instance

Insurance contract or identification number	0000009693
Number of Individuals Covered	1
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $37
Other welfare benefits provided	ACCIDENTAL,CRITICAL ILLNESS,HOSPITA
Welfare Benefit Premiums Paid to Carrier	USD $320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009511

Policy instance

Insurance contract or identification number	0000009511
Number of Individuals Covered	50
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,352
Other welfare benefits provided	ACCIDENT,CRITICAL ILLNESS,HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $206,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $784
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 302458

Policy instance

Insurance contract or identification number	VPL 302458
Number of Individuals Covered	90
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $6,756
Other welfare benefits provided	VOLUNTARY LONG TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $67,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,756
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 327402

Policy instance

Insurance contract or identification number	VPS 327402
Number of Individuals Covered	103
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $3,905
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $39,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,905
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95348 )

Policy contract number

400107

Policy instance

Insurance contract or identification number	400107
Number of Individuals Covered	211
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $88,298
Total amount of fees paid to insurance company	USD $4,997
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,226,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,298
Amount paid for insurance broker fees	4997
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

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

Policy contract number

400107

Policy instance

Insurance contract or identification number	400107
Number of Individuals Covered	217
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $5,244
Total amount of fees paid to insurance company	USD $5,879
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,244
Amount paid for insurance broker fees	5879
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAI 869765

Policy instance

Insurance contract or identification number	VAI 869765
Number of Individuals Covered	41
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,935
Total amount of fees paid to insurance company	USD $74
Other welfare benefits provided	VOLUNTARY ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $9,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,935
Amount paid for insurance broker fees	74
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VCI 869763

Policy instance

Insurance contract or identification number	VCI 869763
Number of Individuals Covered	58
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $1,619
Total amount of fees paid to insurance company	USD $126
Other welfare benefits provided	VOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $19,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,619
Amount paid for insurance broker fees	126
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41125

Policy instance

Insurance contract or identification number	41125
Number of Individuals Covered	201
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $546
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $546
Insurance broker organization code?	3

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

Policy contract number

400107

Policy instance

Insurance contract or identification number	400107
Number of Individuals Covered	185
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $4,961
Total amount of fees paid to insurance company	USD $1,116
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,961
Amount paid for insurance broker fees	1116
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95348 )

Policy contract number

400107

Policy instance

Insurance contract or identification number	400107
Number of Individuals Covered	180
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $74,134
Total amount of fees paid to insurance company	USD $16,400
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,805,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $74,134
Amount paid for insurance broker fees	16400
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WN474

Policy instance

Insurance contract or identification number	WN474
Number of Individuals Covered	13
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,182
Other welfare benefits provided	ACCIDENT/HOSPITAL/LIFE/STD/CANCER
Welfare Benefit Premiums Paid to Carrier	USD $10,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $77
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WT871

Policy instance

Insurance contract or identification number	WT871
Number of Individuals Covered	23
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,572
Other welfare benefits provided	ACCIDENT, CANCER, SICKNESS
Welfare Benefit Premiums Paid to Carrier	USD $20,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,830
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ683

Policy instance

Insurance contract or identification number	WJ683
Number of Individuals Covered	23
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $2,977
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $27,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $716
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ714

Policy instance

Insurance contract or identification number	WJ714
Number of Individuals Covered	16
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $1,812
Other welfare benefits provided	STD, HOSPITAL, PERSONAL TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $18,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $597
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009693

Policy instance

Insurance contract or identification number	0000009693
Number of Individuals Covered	46
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $26
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $320
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
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009511

Policy instance

Insurance contract or identification number	0000009511
Number of Individuals Covered	325
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $3,190
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $36,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,000
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 302458

Policy instance

Insurance contract or identification number	VPL 302458
Number of Individuals Covered	72
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $5,357
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,357
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 327402

Policy instance

Insurance contract or identification number	VPS 327402
Number of Individuals Covered	72
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $2,509
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,509
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ714

Policy instance

Insurance contract or identification number	WJ714
Number of Individuals Covered	20
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,965
Other welfare benefits provided	STD, HOSPITAL, PERSONAL TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $19,222
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
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ683

Policy instance

Insurance contract or identification number	WJ683
Number of Individuals Covered	26
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,668
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $24,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $708
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WT871

Policy instance

Insurance contract or identification number	WT871
Number of Individuals Covered	21
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,375
Other welfare benefits provided	ACCIDENT, CANCER, SICKNESS
Welfare Benefit Premiums Paid to Carrier	USD $20,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,137
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WN474

Policy instance

Insurance contract or identification number	WN474
Number of Individuals Covered	18
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,467
Other welfare benefits provided	ACCIDENT/HOSPITAL/LIFE/STD/CANCER
Welfare Benefit Premiums Paid to Carrier	USD $13,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $313
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41125

Policy instance

Insurance contract or identification number	41125
Number of Individuals Covered	198
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $569
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $569
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009693

Policy instance

Insurance contract or identification number	0000009693
Number of Individuals Covered	46
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $18
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $533
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
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009511

Policy instance

Insurance contract or identification number	0000009511
Number of Individuals Covered	325
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,856
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $45,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $893
Insurance broker organization code?	3

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

Policy contract number

918375

Policy instance

Insurance contract or identification number	918375
Number of Individuals Covered	160
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of fees paid to insurance company	USD $40,740
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,812,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	40740
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 302458

Policy instance

Insurance contract or identification number	VPL 302458
Number of Individuals Covered	34
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $4,512
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,512
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 327402

Policy instance

Insurance contract or identification number	VPS 327402
Number of Individuals Covered	38
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,400
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,400
Insurance broker organization code?	3

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

Policy contract number

0918375

Policy instance

Insurance contract or identification number	0918375
Number of Individuals Covered	182
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $3,479
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,479
Insurance broker organization code?	3

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

Policy contract number

0918375

Policy instance

Insurance contract or identification number	0918375
Number of Individuals Covered	144
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,019
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,019
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 302458

Policy instance

Insurance contract or identification number	VPL 302458
Number of Individuals Covered	25
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $4,036
Total amount of fees paid to insurance company	USD $603
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,036
Amount paid for insurance broker fees	603
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 327402

Policy instance

Insurance contract or identification number	VPS 327402
Number of Individuals Covered	45
Insurance policy start date	2019-04-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $511
Total amount of fees paid to insurance company	USD $152
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $511
Amount paid for insurance broker fees	152
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 327402

Policy instance

Insurance contract or identification number	VPS 327402
Number of Individuals Covered	31
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,091
Total amount of fees paid to insurance company	USD $313
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,091
Amount paid for insurance broker fees	313
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 302458

Policy instance

Insurance contract or identification number	VPL 302458
Number of Individuals Covered	39
Insurance policy start date	2019-04-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $916
Total amount of fees paid to insurance company	USD $333
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $916
Amount paid for insurance broker fees	333
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

918375

Policy instance

Insurance contract or identification number	918375
Number of Individuals Covered	428
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $5,662
Total amount of fees paid to insurance company	USD $41,215
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,796,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,662
Amount paid for insurance broker fees	41215
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009511

Policy instance

Insurance contract or identification number	0000009511
Number of Individuals Covered	325
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $4,237
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $49,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,327
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009693

Policy instance

Insurance contract or identification number	0000009693
Number of Individuals Covered	46
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $26
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $320
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
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41125

Policy instance

Insurance contract or identification number	41125
Number of Individuals Covered	201
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $617
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $617
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ714

Policy instance

Insurance contract or identification number	WJ714
Number of Individuals Covered	21
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,034
Other welfare benefits provided	STD, HOSPITAL, PERSONAL TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $19,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $685
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ683

Policy instance

Insurance contract or identification number	WJ683
Number of Individuals Covered	30
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,576
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $23,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $702
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WT871

Policy instance

Insurance contract or identification number	WT871
Number of Individuals Covered	29
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $3,256
Total amount of fees paid to insurance company	USD $35
Other welfare benefits provided	ACCIDENT, CANCER, SICKNESS
Welfare Benefit Premiums Paid to Carrier	USD $27,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,442
Insurance broker organization code?	3
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	FEES

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WN474

Policy instance

Insurance contract or identification number	WN474
Number of Individuals Covered	21
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,641
Other welfare benefits provided	ACCIDENT/HOSPITAL/LIFE/STD/CANCER
Welfare Benefit Premiums Paid to Carrier	USD $14,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $356
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009511

Policy instance

Insurance contract or identification number	0000009511
Number of Individuals Covered	325
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $5,078
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $57,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,594
Insurance broker organization code?	3

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0061866-01

Policy instance

Insurance contract or identification number	0061866-01
Number of Individuals Covered	197
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $47,236
Total amount of fees paid to insurance company	USD $52
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $47,236
Amount paid for insurance broker fees	52
Insurance broker organization code?	3

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

W40269

Policy instance

Insurance contract or identification number	W40269
Number of Individuals Covered	292
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,055
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,055
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WT871

Policy instance

Insurance contract or identification number	WT871
Number of Individuals Covered	37
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $4,085
Total amount of fees paid to insurance company	USD $53
Other welfare benefits provided	ACCIDENT, CANCER, SICKNESS
Welfare Benefit Premiums Paid to Carrier	USD $32,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,703
Amount paid for insurance broker fees	38
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ683

Policy instance

Insurance contract or identification number	WJ683
Number of Individuals Covered	32
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,961
Total amount of fees paid to insurance company	USD $61
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $26,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $827
Amount paid for insurance broker fees	43
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ714

Policy instance

Insurance contract or identification number	WJ714
Number of Individuals Covered	23
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,161
Other welfare benefits provided	STD, HOSPITAL, PERSONAL TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $21,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $729
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WN474

Policy instance

Insurance contract or identification number	WN474
Number of Individuals Covered	22
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,037
Other welfare benefits provided	ACCIDENT/HOSPITAL/LIFE/STD/CANCER
Welfare Benefit Premiums Paid to Carrier	USD $18,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $451
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009693

Policy instance

Insurance contract or identification number	0000009693
Number of Individuals Covered	46
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $673
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $5,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $178
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 302458

Policy instance

Insurance contract or identification number	VPL 302458
Number of Individuals Covered	55
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $4,096
Total amount of fees paid to insurance company	USD $765
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,096
Amount paid for insurance broker fees	765
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 327402

Policy instance

Insurance contract or identification number	VPS 327402
Number of Individuals Covered	58
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $1,988
Total amount of fees paid to insurance company	USD $389
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,988
Amount paid for insurance broker fees	389
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41125

Policy instance

Insurance contract or identification number	41125
Number of Individuals Covered	226
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $618
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $6,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $618
Insurance broker organization code?	3

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

248233

Policy instance

Insurance contract or identification number	248233
Number of Individuals Covered	191
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $3,998
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,998
Insurance broker organization code?	3

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WN474

Policy instance

Insurance contract or identification number	WN474
Number of Individuals Covered	27
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $2,440
Total amount of fees paid to insurance company	USD $82
Other welfare benefits provided	ACCIDENT/HOSPITAL/LIFE/STD/CANCER
Welfare Benefit Premiums Paid to Carrier	USD $19,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $562
Amount paid for insurance broker fees	67
Insurance broker organization code?	3
Insurance broker name	WILLIAM ROBERTS

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41125

Policy instance

Insurance contract or identification number	41125
Number of Individuals Covered	238
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $656
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, BASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $13,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $656
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

248233

Policy instance

Insurance contract or identification number	248233
Number of Individuals Covered	190
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $3,876
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,876
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00172936

Policy instance

Insurance contract or identification number	00172936
Number of Individuals Covered	299
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $2,092
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,092
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 327402

Policy instance

Insurance contract or identification number	VPS 327402
Number of Individuals Covered	66
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $2,088
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,088
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WT871

Policy instance

Insurance contract or identification number	WT871
Number of Individuals Covered	40
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $4,983
Total amount of fees paid to insurance company	USD $232
Other welfare benefits provided	ACCIDENT, CANCER, SICKNESS
Welfare Benefit Premiums Paid to Carrier	USD $36,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,309
Amount paid for insurance broker fees	166
Insurance broker organization code?	3
Insurance broker name	WILLIAM ROBERTS

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ683

Policy instance

Insurance contract or identification number	WJ683
Number of Individuals Covered	35
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $3,850
Total amount of fees paid to insurance company	USD $62
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $29,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,206
Amount paid for insurance broker fees	13
Insurance broker organization code?	3
Insurance broker name	ASSUREDPARTNERS OF KENTUCKY, LLC

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ714

Policy instance

Insurance contract or identification number	WJ714
Number of Individuals Covered	28
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $2,741
Total amount of fees paid to insurance company	USD $116
Other welfare benefits provided	STD, HOSPITAL, PERSONAL TERM LIFE
Welfare Benefit Premiums Paid to Carrier	USD $24,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $855
Amount paid for insurance broker fees	9
Insurance broker organization code?	3
Insurance broker name	RONALD GRETHEL

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009693

Policy instance

Insurance contract or identification number	0000009693
Number of Individuals Covered	45
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,012
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $8,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $336
Insurance broker organization code?	3
Insurance broker name	INGER M PENNINGTON

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009511

Policy instance

Insurance contract or identification number	0000009511
Number of Individuals Covered	325
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $8,120
Other welfare benefits provided	ACCIDENT/CRITICAL ILLNESS/HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $78,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,508
Insurance broker organization code?	3
Insurance broker name	WILLIAM ROBERTS

MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )

Policy contract number

0061866-01

Policy instance

Insurance contract or identification number	0061866-01
Number of Individuals Covered	193
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $46,357
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,357
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 302458

Policy instance

Insurance contract or identification number	VPL 302458
Number of Individuals Covered	62
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $4,121
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,121
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

248233

Policy instance

Insurance contract or identification number	248233
Number of Individuals Covered	180
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $3,548
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,548
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

41125

Policy instance

Insurance contract or identification number	41125
Number of Individuals Covered	216
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $651
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, BASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to Carrier	USD $13,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $651
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WN474

Policy instance

Insurance contract or identification number	WN474
Number of Individuals Covered	66
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $7,405
Total amount of fees paid to insurance company	USD $175
Welfare Benefit Premiums Paid to Carrier	USD $48,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,030
Amount paid for insurance broker fees	116
Insurance broker organization code?	3
Insurance broker name	SCOTT A SMITH

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WT871

Policy instance

Insurance contract or identification number	WT871
Number of Individuals Covered	51
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $4,975
Total amount of fees paid to insurance company	USD $286
Welfare Benefit Premiums Paid to Carrier	USD $36,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,391
Amount paid for insurance broker fees	178
Insurance broker organization code?	3
Insurance broker name	KYLE DUANE DAFLER

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

00172936

Policy instance

Insurance contract or identification number	00172936
Number of Individuals Covered	259
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $45,427
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,605,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,427
Insurance broker organization code?	3
Insurance broker name	LANG FINANCIAL GROUP, INC.

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ714

Policy instance

Insurance contract or identification number	WJ714
Number of Individuals Covered	46
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $4,625
Total amount of fees paid to insurance company	USD $22
Welfare Benefit Premiums Paid to Carrier	USD $27,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,764
Amount paid for insurance broker fees	13
Insurance broker organization code?	3
Insurance broker name	MICHAEL J QUINN

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009693

Policy instance

Insurance contract or identification number	0000009693
Number of Individuals Covered	45
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $916
Welfare Benefit Premiums Paid to Carrier	USD $8,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $271
Insurance broker organization code?	3
Insurance broker name	SHAWN M MCDERMOTT

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000009511

Policy instance

Insurance contract or identification number	0000009511
Number of Individuals Covered	319
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $11,800
Welfare Benefit Premiums Paid to Carrier	USD $72,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25
Insurance broker organization code?	3
Insurance broker name	BRIAN J DAY

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

WJ683

Policy instance

Insurance contract or identification number	WJ683
Number of Individuals Covered	69
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $8,949
Welfare Benefit Premiums Paid to Carrier	USD $61,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,676
Insurance broker organization code?	3
Insurance broker name	ASSUREDPARTNERS OF KENTUCKY, LLC

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Company Name:	MATT CASTRUCCI, INC.
Employer identification number (EIN):	310871089
NAIC Classification:	441110
NAIC Description:	New Car Dealers