401k Plan data: MC NEIL AKRON LIFE & HEALTH PLAN plan

MC NEIL AKRON LIFE & HEALTH PLAN 401k Plan overview

Plan Name	MC NEIL AKRON LIFE & HEALTH PLAN
Plan identification number	501

MC NEIL AKRON LIFE & HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MCNEIL & NRM INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: MCNEIL & NRM INTERNATIONAL, INC.

Employer identification number (EIN): 341303350

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MC NEIL AKRON LIFE & HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-01-01
501 2018-01-01 YVONNE K. KERRIGAN 2020-08-14 R. A. NELSON 2020-08-14
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01 YVONNE K. KERRIGAN
501 2012-01-01 YVONNE K. KERRIGAN
501 2011-01-01 LYNDEN GAMBLE
501 2009-01-01 LYNDEN GAMBLE J A SIEGFRIED 2010-07-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-01-01
501	2018-01-01	YVONNE K. KERRIGAN	2020-08-14	R. A. NELSON	2020-08-14
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01	YVONNE K. KERRIGAN
501	2012-01-01	YVONNE K. KERRIGAN
501	2011-01-01	LYNDEN GAMBLE
501	2009-01-01	LYNDEN GAMBLE		J A SIEGFRIED	2010-07-19

Plan Statistics for MC NEIL AKRON LIFE & HEALTH PLAN

401k plan membership statisitcs for MC NEIL AKRON LIFE & HEALTH PLAN

Measure Date Value
2018: MC NEIL AKRON LIFE & HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 75
Number of retired or separated participants receiving benefits 2018-01-01 13
Total of all active and inactive participants 2018-01-01 88
2017: MC NEIL AKRON LIFE & HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 76
Number of retired or separated participants receiving benefits 2017-01-01 13
Total of all active and inactive participants 2017-01-01 89
2016: MC NEIL AKRON LIFE & HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 96
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 77
Number of retired or separated participants receiving benefits 2016-01-01 16
Total of all active and inactive participants 2016-01-01 93
2015: MC NEIL AKRON LIFE & HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 80
Number of retired or separated participants receiving benefits 2015-01-01 16
Total of all active and inactive participants 2015-01-01 96
2014: MC NEIL AKRON LIFE & HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 72
Number of retired or separated participants receiving benefits 2014-01-01 26
Total of all active and inactive participants 2014-01-01 98
2013: MC NEIL AKRON LIFE & HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 79
Number of retired or separated participants receiving benefits 2013-01-01 26
Total of all active and inactive participants 2013-01-01 105
Total participants 2013-01-01 105
2012: MC NEIL AKRON LIFE & HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 75
Number of retired or separated participants receiving benefits 2012-01-01 28
Total of all active and inactive participants 2012-01-01 103
Total participants 2012-01-01 103
2011: MC NEIL AKRON LIFE & HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 67
Number of retired or separated participants receiving benefits 2011-01-01 35
Total of all active and inactive participants 2011-01-01 102
Total participants 2011-01-01 102
2009: MC NEIL AKRON LIFE & HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 70
Number of retired or separated participants receiving benefits 2009-01-01 55
Total of all active and inactive participants 2009-01-01 125
Total participants 2009-01-01 125

Measure	Date	Value
2018: MC NEIL AKRON LIFE & HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	75
Number of retired or separated participants receiving benefits	2018-01-01	13
Total of all active and inactive participants	2018-01-01	88
2017: MC NEIL AKRON LIFE & HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	76
Number of retired or separated participants receiving benefits	2017-01-01	13
Total of all active and inactive participants	2017-01-01	89
2016: MC NEIL AKRON LIFE & HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	96
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	77
Number of retired or separated participants receiving benefits	2016-01-01	16
Total of all active and inactive participants	2016-01-01	93
2015: MC NEIL AKRON LIFE & HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	80
Number of retired or separated participants receiving benefits	2015-01-01	16
Total of all active and inactive participants	2015-01-01	96
2014: MC NEIL AKRON LIFE & HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	72
Number of retired or separated participants receiving benefits	2014-01-01	26
Total of all active and inactive participants	2014-01-01	98
2013: MC NEIL AKRON LIFE & HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	79
Number of retired or separated participants receiving benefits	2013-01-01	26
Total of all active and inactive participants	2013-01-01	105
Total participants	2013-01-01	105
2012: MC NEIL AKRON LIFE & HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	75
Number of retired or separated participants receiving benefits	2012-01-01	28
Total of all active and inactive participants	2012-01-01	103
Total participants	2012-01-01	103
2011: MC NEIL AKRON LIFE & HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	67
Number of retired or separated participants receiving benefits	2011-01-01	35
Total of all active and inactive participants	2011-01-01	102
Total participants	2011-01-01	102
2009: MC NEIL AKRON LIFE & HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	70
Number of retired or separated participants receiving benefits	2009-01-01	55
Total of all active and inactive participants	2009-01-01	125
Total participants	2009-01-01	125

Form 5500 Responses for MC NEIL AKRON LIFE & HEALTH PLAN

2018: MC NEIL AKRON LIFE & HEALTH PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MC NEIL AKRON LIFE & HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MC NEIL AKRON LIFE & HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MC NEIL AKRON LIFE & HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MC NEIL AKRON LIFE & HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MC NEIL AKRON LIFE & HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MC NEIL AKRON LIFE & HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MC NEIL AKRON LIFE & HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: MC NEIL AKRON LIFE & HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

0X7571

Policy instance

Insurance contract or identification number	0X7571
Number of Individuals Covered	159
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $68,668
Total amount of fees paid to insurance company	USD $1,080
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,504,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $68,668
Amount paid for insurance broker fees	1080
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )

Policy contract number

0001379

Policy instance

Insurance contract or identification number	0001379
Number of Individuals Covered	155
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,212
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,212
Insurance broker organization code?	3

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

Policy contract number

SGM603236

Policy instance

Insurance contract or identification number	SGM603236
Number of Individuals Covered	75
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $2,308
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,308
Insurance broker organization code?	3

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

Policy contract number

SGD603177

Policy instance

Insurance contract or identification number	SGD603177
Number of Individuals Covered	75
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $2,622
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,622
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

AGP-003018

Policy instance

Insurance contract or identification number	AGP-003018
Number of Individuals Covered	12
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,356
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	MEDICARE SUPPLEMENT
Welfare Benefit Premiums Paid to Carrier	USD $122,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,264
Insurance broker organization code?	3

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

Policy contract number

SOK602059

Policy instance

Insurance contract or identification number	SOK602059
Number of Individuals Covered	75
Insurance policy start date	2017-05-01
Insurance policy end date	2018-05-01
Total amount of commissions paid to insurance broker	USD $443
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $443
Insurance broker organization code?	3

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

AGP-003018

Policy instance

Insurance contract or identification number	AGP-003018
Number of Individuals Covered	12
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,548
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,548
Insurance broker organization code?	3
Insurance broker name	DANIEL N. CLODFELTER

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

Policy contract number

SGD603177

Policy instance

Insurance contract or identification number	SGD603177
Number of Individuals Covered	77
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $2,797
Total amount of fees paid to insurance company	USD $104
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,520
Insurance broker organization code?	3
Amount paid for insurance broker fees	104
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SGM603236

Policy instance

Insurance contract or identification number	SGM603236
Number of Individuals Covered	77
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $2,462
Total amount of fees paid to insurance company	USD $165
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,330
Amount paid for insurance broker fees	165
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Insurance broker name	DIGITAL INSURANCE LLC

DELTA DENTAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 54402 )

Policy contract number

0001379

Policy instance

Insurance contract or identification number	0001379
Number of Individuals Covered	149
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,161
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,161
Insurance broker organization code?	3
Insurance broker name	DIGITAL INSURANCE LLC

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

Policy contract number

00X7571

Policy instance

Insurance contract or identification number	00X7571
Number of Individuals Covered	162
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $59,235
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,273,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,235
Insurance broker organization code?	3
Insurance broker name	DIGITAL INSURANCE LLC

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

Policy contract number

SOK602059

Policy instance

Insurance contract or identification number	SOK602059
Number of Individuals Covered	77
Insurance policy start date	2016-05-01
Insurance policy end date	2017-05-01
Total amount of commissions paid to insurance broker	USD $454
Total amount of fees paid to insurance company	USD $21
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $249
Insurance broker organization code?	3
Amount paid for insurance broker fees	21
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SGM603236

Policy instance

Insurance contract or identification number	SGM603236
Number of Individuals Covered	82
Insurance policy start date	2014-05-01
Insurance policy end date	2015-05-01
Total amount of commissions paid to insurance broker	USD $2,002
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,002
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SGD603177

Policy instance

Insurance contract or identification number	SGD603177
Number of Individuals Covered	82
Insurance policy start date	2014-05-01
Insurance policy end date	2015-05-01
Total amount of commissions paid to insurance broker	USD $1,950
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,950
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SOK602059

Policy instance

Insurance contract or identification number	SOK602059
Number of Individuals Covered	82
Insurance policy start date	2014-05-01
Insurance policy end date	2015-05-01
Total amount of commissions paid to insurance broker	USD $400
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $400
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

SUMMACARE (National Association of Insurance Commissioners NAIC id number: 95202 )

Policy contract number

G01655

Policy instance

Insurance contract or identification number	G01655
Number of Individuals Covered	172
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $16,375
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,490,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,375
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INSURANCE AGENCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

APG-003018

Policy instance

Insurance contract or identification number	APG-003018
Number of Individuals Covered	20
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,836
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $159,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,836
Insurance broker organization code?	3
Insurance broker name	DANIEL N. CLODFELTER

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

Policy contract number

TM05992241

Policy instance

Insurance contract or identification number	TM05992241
Number of Individuals Covered	72
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $2,449
Total amount of fees paid to insurance company	USD $878
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,449
Amount paid for insurance broker fees	878
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INS AGCY OF OH INC

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

Policy contract number

SGM603236

Policy instance

Insurance contract or identification number	SGM603236
Number of Individuals Covered	72
Insurance policy start date	2013-05-01
Insurance policy end date	2014-05-01
Total amount of commissions paid to insurance broker	USD $1,867
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 $19,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,867
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SGD603177

Policy instance

Insurance contract or identification number	SGD603177
Number of Individuals Covered	72
Insurance policy start date	2013-05-01
Insurance policy end date	2014-05-01
Total amount of commissions paid to insurance broker	USD $1,794
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 $11,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,794
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SOK602059

Policy instance

Insurance contract or identification number	SOK602059
Number of Individuals Covered	72
Insurance policy start date	2013-05-01
Insurance policy end date	2014-05-01
Total amount of commissions paid to insurance broker	USD $363
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	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $363
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

SUMMACARE (National Association of Insurance Commissioners NAIC id number: 95202 )

Policy contract number

G01655

Policy instance

Insurance contract or identification number	G01655
Number of Individuals Covered	163
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,680
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,209,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,680
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INSURANCE AGENCY

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

Policy contract number

TM05992241

Policy instance

Insurance contract or identification number	TM05992241
Number of Individuals Covered	152
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $2,298
Total amount of fees paid to insurance company	USD $795
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 $44,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,298
Amount paid for insurance broker fees	795
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INS AGCY OF OH INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

APG-003018

Policy instance

Insurance contract or identification number	APG-003018
Number of Individuals Covered	20
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $18,385
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $197,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,385
Insurance broker organization code?	3
Insurance broker name	DANIEL N. CLODFELTER

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

Policy contract number

TM05992241

Policy instance

Insurance contract or identification number	TM05992241
Number of Individuals Covered	150
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $2,146
Total amount of fees paid to insurance company	USD $712
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,146
Amount paid for insurance broker fees	712
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INS AGCY OF OH INC

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

Policy contract number

SGM603236

Policy instance

Insurance contract or identification number	SGM603236
Number of Individuals Covered	79
Insurance policy start date	2012-05-01
Insurance policy end date	2013-05-01
Total amount of commissions paid to insurance broker	USD $1,876
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,876
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SGD603177

Policy instance

Insurance contract or identification number	SGD603177
Number of Individuals Covered	79
Insurance policy start date	2012-05-01
Insurance policy end date	2013-05-01
Total amount of commissions paid to insurance broker	USD $1,690
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,690
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

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

Policy contract number

SOK602059

Policy instance

Insurance contract or identification number	SOK602059
Number of Individuals Covered	79
Insurance policy start date	2012-05-01
Insurance policy end date	2013-05-01
Total amount of commissions paid to insurance broker	USD $346
Other welfare benefits provided	MEDICAL INDEMNITY, ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $346
Insurance broker organization code?	3
Insurance broker name	WILLIS OF OHIO INC

SUMMACARE (National Association of Insurance Commissioners NAIC id number: 95202 )

Policy contract number

G01655

Policy instance

Insurance contract or identification number	G01655
Number of Individuals Covered	192
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $18,300
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,084,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,300
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INSURANCE AGENCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

APG-003018

Policy instance

Insurance contract or identification number	APG-003018
Number of Individuals Covered	28
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $20,328
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $217,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,328
Insurance broker organization code?	3
Insurance broker name	DANIEL N. CLODFELTER

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

Policy contract number

010-035162

Policy instance

Insurance contract or identification number	010-035162
Number of Individuals Covered	127
Insurance policy start date	2012-01-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $802
Total amount of fees paid to insurance company	USD $418
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $802
Insurance broker organization code?	3
Amount paid for insurance broker fees	418
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	WILLIS INS SVCS OF CALIFORNIA INC

SUMMACARE (National Association of Insurance Commissioners NAIC id number: 95202 )

Policy contract number

G01655

Policy instance

Insurance contract or identification number	G01655
Number of Individuals Covered	191
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $17,660
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,018,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,660
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INSURANCE AGENCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

AGP-003018

Policy instance

Insurance contract or identification number	AGP-003018
Number of Individuals Covered	28
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $22,498
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $241,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,498
Insurance broker organization code?	3
Insurance broker name	DANIEL N. CLODFELTER

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

Policy contract number

75527

Policy instance

Insurance contract or identification number	75527
Number of Individuals Covered	75
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $3,744
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,744
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INS AGCY OF OH INC

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

Policy contract number

75527

Policy instance

Insurance contract or identification number	75527
Number of Individuals Covered	70
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $3,566
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $30,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

010-035162

Policy instance

Insurance contract or identification number	010-035162
Number of Individuals Covered	136
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $2,392
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

TM05711571

Policy instance

Insurance contract or identification number	TM05711571
Number of Individuals Covered	134
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $410
Total amount of fees paid to insurance company	USD $260
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUMMACARE (National Association of Insurance Commissioners NAIC id number: 95202 )

Policy contract number

G01655

Policy instance

Insurance contract or identification number	G01655
Number of Individuals Covered	163
Insurance policy start date	2010-09-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $27,632
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $921,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

AGP-003018

Policy instance

Insurance contract or identification number	AGP-003018
Number of Individuals Covered	34
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $27,842
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $291,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

TM05711571

Policy instance

Insurance contract or identification number	TM05711571
Number of Individuals Covered	134
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $2,078
Total amount of fees paid to insurance company	USD $16
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,947
Commission paid to Insurance Broker	USD $2,078
Amount paid for insurance broker fees	16
Additional information about fees paid to insurance broker	NONMONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS CORROON OF OHIO

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

Policy contract number

TM05711571

Policy instance

Insurance contract or identification number	TM05711571
Number of Individuals Covered	134
Insurance policy start date	2010-04-01
Insurance policy end date	2010-04-30
Total amount of commissions paid to insurance broker	USD $216
Total amount of fees paid to insurance company	USD $165
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,018
Commission paid to Insurance Broker	USD $216
Amount paid for insurance broker fees	165
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIS CORROON OF OHIO

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

AGP-003018

Policy instance

Insurance contract or identification number	AGP-003018
Number of Individuals Covered	45
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $37,416
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $362,760
Commission paid to Insurance Broker	USD $37,416
Insurance broker organization code?	3
Insurance broker name	DANIEL N. CLODFELTER

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

Policy contract number

75527

Policy instance

Insurance contract or identification number	75527
Number of Individuals Covered	70
Insurance policy start date	2009-05-01
Insurance policy end date	2010-04-30
Total amount of commissions paid to insurance broker	USD $3,819
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $33,037
Commission paid to Insurance Broker	USD $3,819
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INS AGCY OF OH INC

SUMMACARE (National Association of Insurance Commissioners NAIC id number: 95202 )

Policy contract number

G01655

Policy instance

Insurance contract or identification number	G01655
Number of Individuals Covered	173
Insurance policy start date	2009-09-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $25,902
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $863,415
Commission paid to Insurance Broker	USD $25,902
Insurance broker organization code?	3
Insurance broker name	WILLIS LIFE INSURANCE AGENCY

Potentially related plans

MC NEIL 401(K) PROFIT SHARING PLAN [EIN = 462628594]

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Company Name:	MCNEIL & NRM INTERNATIONAL, INC.
Employer identification number (EIN):	341303350
NAIC Classification:	339900